Reduction Rhinoplasty. Advanced Surgical Techniques

Introduction. The problem of reduction of a massive, overprojected,  broad, boxy or bulbous nose with wide nostrils remains one of the most challenging and urgent items for surgeons who perform aesthetic rhinoplasty. Many important details of  such noses surgical correction frequently are not  taken into consideration and even ignored by many specialists in this field.

Objective. After operating on more than 1850 noses for 18 years we would like to review the surgical methods we use when correcting a bulbous or overprojected nose with slack, loose skin, often porous, with the marked subcutaneous tissue and a thick epithelial layer. The author’s methods  help  reduce the size of a skin envelope and create a more refined, accurate, well-defined nasal tip.

Materials and methods. We are going to review the following topics:

1) Additional advanced surgical techniques in closed and open reduction rhinoplasty when enhancing a massive nose: important advantages of closed and open methods;

2) Importance of preserving and creating extra strength and resiliency for the nasal tip cartilaginous framework;

3) The techniques for providing the conditions, which are necessary for the thin atrophic subcutaneous scar formation in the nasal tip;

4) Nasal skin peculiarities and their impact on the rhinoplasty outcomes;

5) Osteotomy of a massive nose;

6) Airway dysfunction treatment  in aesthetic rhinoplasty;

7) Modifying  bulky, wide nostrils, and application of various ‘cut out patterns’ of a skin nasal envelope;

8) Cartilaginous tip grafts and a thick nose reduction;

9) Anthropometrical compensations for the camouflage of a massive nose;

10) Wide nasal base reduction;

11) Suture techniques for a boxy nasal tip;

12) Complications of a bulbous or overprojected nose rhinoplasty: how to avoid them;

Conclusions. Advanced surgical techniques of reduction rhinoplasty help and open  expanded horizons and extra possibilities for surgeons when operating on ‘difficult’ noses. Those techniques have proved their efficacy through time, and when performed correctly, they can provide a long-lasting, naturalappearing, and functionally pleasing result. Besides, such surgeries have a very low complication  rate  and  high rate of patients’ and a surgeon’s satisfaction with the operations outcomes.

25 сентября 2015