Rhinoplasty

Abstract

RHINOPLASTY IS STILL ONE OF THE MOST DIFFICULT AND CHAL-lenging procedures of cosmetic surgery. Pollybeaks, scar retraction, “floppy septums,” and other problems will plague us to the end of our days. Despite the problems, we are doing a better job now than we were during the 1970s. Back then we used nasal saws to cut through the bone. Now we use a chisel and simply pop the bone inward. We no longer transect the tip cartilages, and we do not see the superresected bird-beak tips that we once associated with Latin Americans. When we add grafts for tip elevation, we choose cartilage, with or without an overdrape of temporalis fascia in the tip of the nose, and know that it will stay there. The open technique has added a dimension to the difficult nose repair, although it is certainly not the procedure of choice for the average rhinoplasty. We are more aware of the turbinates and do not hesitate to cauterize and out-fracture the inferior or even the medial turbinate or resect them, as needed. We are aware that in most rhinoplasty patients only the distal part of the nasal bone flares and a complete bony transection is not necessary, a procedure that certainly caused distressing edema and ecchymoses.