The anatomy of the nasal septum has been outlined in the anatomy and physiology section of septoplasty . However, the midline septal cartilage is one of a number of structures that support and create the framework of the nose. In addition there are two alar (lower lateral) cartlages and two upper lateral cartilages. The upper lateral cartilages snuggly fit under the two nasal bones.
The nasal dorsum in a lateral view is of significant importance to patients aesthetically. Too prominent a nasal dorsum contributed from the nasal septum and nasal bones can produce a nasal hump that can is possible to be reduced.
From a frontal view the nose aesthetically should be in proportion to the eyes and face. The nasal bones and septum together with the alar and upper lateral cartilages should be symmetrical and in line.
Lateral views of the nose demonstrate the nasolabial angle that should be approximately 90-100° in males and 100-110° in females.
Septorhinoplasty surgery is undertaken for functional and cosmetic purposes. There are many aspects that should be taken into account when planning with the patient. It is important to be honest with the patient about what can and cannot be achieved.
Surgery can be undertaken in a closed or open technique. Closed techniques involve incisions in the nose occasionally with tiny stab incisions for bony work around the nasal bones. Open techniques involve a mix of internal incisions together with some external incisions to allow the draping skin of the nose to be reflected to reveal the structural cartilages below. All the cartilages of the nose can be altered in different ways to reshape and support the nose in different ways. The nasal bones can be fractured and repositioned.
Because the surgical work of a septorhinoplasty is based on reshaping and repositioning of cartilages and bones which can include fracturing of bony tissues there can be some associated swelling and bruising that subsides fairly quickly after the operation. The internal incisions are closed with dissolving sutures and the nose is sometimes dressed lightly internally. A supportive plaster of paris or moulded splint is used to protect the newly shaped nose for the first 7-10 days.