Conservative Or Preservative Rhinoplasty: A New Paradigm

Conservative Or Preservative Rhinoplasty: A New Paradigm

Nasal structures cannot be manipulated independently because what we do in one area influences all the others, both in the external appearance and in the way that nose works .

The nose is like a building, if we throw a load-bearing wall, if we modify any part of the main structure, unevenness, cracks or collapses may appear.

What Is Conservative Rhinoplasty And How Is It Different From The Traditional Rhinoplasty That Has Been Done So Far?

The conservative rhinoplasty consists of a set of surgical procedures performed in cartilage, muscles, ligaments and bones of the nose that is modeled preserving its structural and functional integrity , that is, being the least aggressive possible, carrying out a surgical rhinoplasty ultra-conservative , ultra-controlled and objective proofreader following the predictions and instructions previously made with software.

This software plans from “before”; how to make “the during” less aggressive; “The immediate after” or result of that nose and, most importantly, its appearance in time . The latter is very important since aggressive rhinoplasties can give long-term surprises : collapsed noses, fallen tips, irregularities …

For example: in traditional rhinoplasty , which 95% of surgeons do, when the hump or trestle is operated, it is done by cutting the bone from the “roof” of the nasal pyramid, this destroys the anatomy of that area (shape) which is crucial for proper breathing ( function ). Furthermore, it is not uncommon that, when cutting inaccurately, blindly and palpated with a chisel (which is how it is traditionally done), certain imperfections, which are often visible and stigmatic, appear over time. Not to mention the postoperative period.

However, in Conservative Rhinoplasty , with specifically designed manual mini-saws or with ultrasound saws (ultrasonic rhinoplasty), the legs of that pyramid are cut very precisely so that the entire nasal pyramid sinks (as if we were precisely cutting the foundation of a building to bring it down).

Making a smaller pyramid while preserving its dome, only shortening its base and not destroying-rebuilding its roof , seems logical right? Well, sometimes the most logical thing is not the most frequent.

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Surgical Techniques Of Rhinoplasty

The rhinoplasty can treat the nose as a whole, or to focus on parts of the nose segmentally. It all depends on the defects presented by the patient’s nose and their expectations. The surgical project will therefore define for each area of the nose, the need or not for treatment, and the best operating strategy.

Rhinoplasty Techniques Have Only One Goal: A Natural Result

Talking about the natural result of rhinoplasty has become commonplace. Which Surgeon Would Like To Do Unnatural Rhinoplasties? None Of Course!

Rather, the questions are:

  • How to set up an operative project that gives a natural result?
  • How Can We Technically Ensure That In A Certain And Reproducible Way, The Result Is Natural, Regardless Of The Type Of Nose?
  • What technical gestures will precisely make it possible to achieve this?

I have defined what I consider to be the key points at the technical level for an operative project that leads to a natural and harmonious result.

The Different Subunits Of The Nose To Be Treated

The nose is made up of 4 subunits

  • the tip (yellow)
  • the dorsum (green)
  • the root of the nose above the dorsum (in red)
  • nostrils (blue)

Each of these sub-units is subjected to a preoperative analysis, which should lead to the final project.

Surgical Techniques Treat The Nose Area By Area

Tip Of The Nose Rhinoplasty Techniques

The surgery of the nose tip is central in rhinoplasty. It treats all the anomalies of the tip:

  • point too wide, round, without shape or on the contrary point too pinched
  • point too thrown or on the contrary too far back
  • falling point or on the contrary too raised

The techniques are based on Cartilage Grafts And Sutures.

Nasal Dorsum Rhinoplasty Techniques

It consists of harmonizing the profile line , according to the patient’s wishes: straight profile, slightly hollowed out or with a small remaining bump.

The Most Classic Is Rhinoplasty For Nasal Hump

The surgery of the nasal hump removes excess bone and cartilage forming the nasal hump, to redraw a clean and smooth profile.

A fundamental point to understand is that the reduction of the hump improves the profile, but has repercussions on the nose when viewed from the front. It is common for a pinch of the triangular cartilages to create an inverted V deformity after removal of a lump.

In order to avoid this, we systematically carry out spreader grafts to avoid this phenomenon, that is to say structural grafts of the nose that prevent the pinching of the triangular cartilages. Specialists  this rhinoplasty surgery in Miami.

Rhinoplasty For Too Deep Nose Or Nasal Saddle

The noses that are too deep are unsightly, because they are often the signature of a previous poorly dosed rhinoplasty. The nasal brace can also be constitutional by insufficient growth of the proper bones of the nose.

The rhinoplasty for nose dug rely on transplants positioned along the dorsum under the skin.

Our preference today is for a compound graft called DCF , made of micro-diced cartilage taken from the ear or ribs, and temporal fascia. Because this graft is easily modeled because of its malleability, and thus gives excellent results.

Rhinoplasty To Reduce The Width Of The Bones Of The Nose

The bony base of the nose implanted on the face may be too wide. It is then necessary to reduce the bone base by targeted fractures of the bones in order to reposition them and thus reduce the width of the base of the nose.

Nose Root Rhinoplasty Techniques

The root of the nose is the upper part of the nose located between the eyes, that is, at the beginning of the nose from the forehead.

Surgery of the root of the nose is essential to harmonize the profile line:

  • A too high root of the nose gives a too straight nose which starts from the forehead. It will therefore be necessary to reduce the root, by moving it back
  • A root of the nose that is too low gives the impression of a nose that is too hollow and too long. It will therefore be necessary to perform a transplant to fill the root of the nose. In the event of a nasal lump associated with a hollow root, root filling may be sufficient to treat the lump by redrawing a straight profile.

Nostril Surgery Techniques

The surgery of the nostrils helps reduce the nostrils too long, or to reduce the nasal threshold if too nostrils.

It can also make it possible to correct the contours of the nostril wings when they are too retracted. This is often the case after a previous rhinoplasty which has resected too much cartilage.

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From Traditional Rhinoplasty …

With its new mainly aesthetic function, the demands on rhinoplasty have changed. Patients no longer want to repair their nose to get closer to normal, but to beautify it to get closer to perfection.

Traditional rhinoplasty was the first advanced form of cosmetic treatment for the nose, but it is still limited. Indeed, the operation consists, without opening the nose, in making changes through the orifice of the nostril, and using an osteotome (bone saw) to correct the bone part. Nevertheless, the possibilities did not allow to modify the very structure of the nose, but only to take material and “break” the bone, in order to flatten it for example. As a result, it was not possible to make fair and precise corrections, and even in the hands of a very experienced surgeon, it was common to have to make post-healing adjustments.

Due in particular to the use of the osteotome in this surgery, a certain reluctance persisted with regard to traditional rhinoplasty due to its brutal appearance. The nose undergoing significant shocks, the postoperative effects often involved edemas and bruises which could sometimes be painful.

… To Structural Rhinoplasty…

In order to offer a safer, more precise and above all more modern correction, the traditional method had to evolve into a new form: structural rhinoplasty .

The main improvement brought about by this new technique is the possibility of the anatomical reorganization of the nose: it is no longer just a question of removing material, but also of modifying the shape of the cartilages using sutures and cartilage grafts (small pieces of cartilage usually taken from inside the nose, without any harmful consequences when done correctly).

The main advantage of structural rhinoplasty is to change the shape of the nose without the risk of deforming it, while preserving or strengthening respiratory function. Indeed, the internal structures of the nose are not weakened, but only remodeled or reinforced, it is the whole aspect and the future of the nose that we can thus better understand. The disadvantage of this type of intervention is that it is more technical, more delicate, longer, and often requires an open path with a small imperceptible scar between the two nostrils. Nevertheless, the gesture carried out being softened, the postoperative repercussions are easier to bear, less painful, and the results are very satisfactory.
Medical Rhinoplasty

The reputation preceding surgery leads many patients to fear of an unsightly, overly visible and unnatural result. This is the main reason why many are not yet ready to take this step and wish to avoid surgery at all costs.

Thanks to the democratization of the use of hyaluronic acid , its application has been widely derived in aesthetic medicine to treat several parts of our body, and more particularly our face. In an effort to always bring more and more personalized corrections that are more and more easy to bear, it was the trigger for a new form of aesthetic treatment of the nose: medical rhinoplasty .

Unlike previous techniques, the latter does not require any surgical intervention. In order to offer an alternative to surgical rhinoplasties, it was developed precisely with the idea of treating slight defects, not requiring an overly invasive operation.

By means of localized injections, this medical act makes it possible to raise the tip of a nose or to erase a bump for example. Even if its effects wear off after 18 months and only small flaws can be corrected, its simplicity and cost make it an increasingly popular intervention.

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The 5 Minute Nose Job – Non Surgical Rhinoplasty – Beauty Secrets with Dr. Jamuna Pai

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