(Surgical Correction Of The Shape Of The Nose)
Many patients are born with hereditary defects of the nose including a high bridge, a excessively wide nose, or excessively long nose. At times a patient’s, even as children, sustain injury to the nose which not only causes an external deformity of the nose, either creating a cricked nose or an exceptionally wide nose as a result of the injury. In addition to the shape of the nose, the function is extremely important. The internal structure of the nose is such that there is a partition that divides the nose into two nostrils and two nasal airways. That partition or wall is called the septum. A very commonly heard term is a deviated septum and that is a condition where by the wall, which is customarily in the mid-line, is either by heredity or by injury, dislocated and shifted to one side or the other and often times has a bilateral deviation that causes a significant obstruction to breathing. There are anatomical structures inside the nose that are called turbinates, which are the structures that swell. For example, when a patient has a cold. If the turbinates have excessive swelling, or are excessively large, then they abud against the internal wall of the nose, the septum, and they cause a significant obstruction. Enlarged turbinates can be a result of allergies or a hereditary condition.
In addition to the external shape of the nose and the internal nasal obstruction, very often patients have simultaneous sinus conditions which are either allergic or infectious in nature. The sinuses may have conditions known as an acute, or chronic sinusinus and these conditions are very well diagnosed either using conventional x-ray techniques or at times necessitating more exotic diagnostic studies such as: MRI’s or CAT scans. It is very important for the rhino plastic surgeon to do a thuro examination of not only the outside of the nose, but also any internal obstruction to the breathing, as well as the state of the health of the sinuses.
Rhinoplasty (Cosmetic)
A variety of conditions may exist in patients including having noses that are too wide, too long, having an ill defined tip, having an excessively high bridge, or being deviated. The surgeons objective in doing rhinoplasty surgery is to make changes in the nose which then can form to the tenets of beauty which are discussed else where in this website. For the patients purposes, the nose basically consists of three things, lining that is similar to the lining inside your cheeks, there is a bone and cartilage framework that creates the shape of the nose, and then there is a skin covering the nose. The typical rhinoplasty candidate comes into the outpatient center and either has a sedation type anesthesia or a general anesthetic. The procedure is totally painless. The basic concept of the procedure is to make inconspicuous intranasal (inside the nose) incisions so that there are no external, visible scars. The skeletal framework of the nose is exposed and then depending upon the patients condition, the framework is either realigned or reduced in volume to create a straight, more attractive nose. On completion upon the procedure, inside the nose, stitches are placed to close the incisions.
Years ago, and still today, many surgeons use an intranasal packing which creates a tremendous discomfort and may cause extreme swelling and bruising of the area of the eye lids and mid face.
Dr. Brennan, years ago, invented a device which is called a rhino-cap which is a continuous suction device that is placed inside the nose before the surgery begins. This prevents the blood from trickling into the throat which causes the patient to then either swallow the blood or have to cough. One way or the other, the patient then is extremely uncomfortable and either by coughing or vomiting, creates excessive pressure and creates more bleeding and bruising. The devise that Dr. Brennan invented prevents bleeding during the surgical procedure and prevents the discomfort that the patient usually experiences in the recovery room. This device is connected to a continuous suction apparatus and once the nose stops bleeding, the device is removed and there then is no need for the customary packing that most surgeons use when doing rhinoplasty surgery. In patients who have the packing placed, it is an extremely painful and uncomfortable experience. The need for removing the packing sometime after the surgery creates tremendous discomfort to the patient. The use of the rhino-craft obviates all of this and as a result the patient has a very pleasant experience and is not subjected to the trauma of having the intranasal packing. The rhino plastic surgery that is performed at the outpatient center then becomes one that has no visible scars, there is no pain, and no bleeding. After surgery, a very light dressing is applied to the bridge of the nose and the patient is able to have the surgery performed on an outpatient bases. The following morning the patient is seen in the office. Nasal hygiene is performed and the dressings are removed. The patient is able to appreciate the changes were accomplished surgically, now noticing a nose that is straight, smaller, and far more attractive. The patient is then encouraged to engage in normal daily hygiene, normal daily activities, diet, and sleep habits. The vast majority of patients have minimal discomfort and the most that is required is Extra Strength Tylenol but typically the patient has little or no discomfort.
Customarily, the patient who has rhino plastic surgery looks very presentable within a week and the surgery is imperceptible to a stranger. The patient might notice some residual swelling, could have some minimal bruising, but typically looks very presentable in approximately one week.
Correction Of Nasal Obstruction
Some patients have, in addition to an undesirable nasal shape, a simultaneous nasal obstruction either due to a deviated septum or enlarged turbinates. At times, patients have a very attractive nose and simply have obstructive breathing. Regardless of the condition, if a patient has a nasal obstruction, then that obstruction is eliminated either as a separate procedure or in conjunction with cosmetic rhinoplasty. Through incisions made inside the nostril, the obstructing portions of the septum are either re-aligned, or less often removed. But the objective is to have a septum that is, once again, in the mid line as to give the patient a normal anatomy and one that allows the nose to function in a normal manner. In addition to deviations of the septum, at times it is necessary to reduce the enlarge turbinates in the combination of realigning the septum and reducing the turbinates creates a significant potency of the nasal airway as to allow the patient to resume normal breathing.
Once again, the rhinocaft that Dr. Brennan invented is used during this procedure so as to, not only facilitate the surgery, to minimize bleeding, and to create patient comfort. Patients who have intranasal obstruction are ideal candidates for either correction of the septum or the enlarged turbinates or both. These patients usually have a significant improvement in their airway. It must be understood that if a patient has an underlined nasal allergy, that they may periodically seasonal obstruction to their nasal breathing. In such instances the patient must understand that they must be under the care of an allergy type doctor that will treat their conditions.
Sinus Surgery
In patients who have sinus conditions, whether they are acute or chronic, and whether they occur simultaneous with undesirable nasal shape, or internal nasal obstruction, the sinuses are appropriately surgically explored predicated on the results of the diagnostic, radiographic studies performed on the sinuses performed before the surgery. Very sophisticated state of the art instrumentation is used including instruments that are basically like a T.V. camera that are then attached to a large monitor so that the surgeon is able to look into each and every sinus, evaluated under magnification on the TV screen and treat the condition accordingly. This is a highly specialized field of medicine and the procedure has come to be known as the FESS procedure which is Functional Endoscopic Sinus Surgery. Sinus surgery rarely needs nasal dressings and is performed on an outpatient basis. It is generally performed under a very light anesthesia. The patient, once recovered, is aloud to leave the facility under the care of a responsible adult. Typically the patient is seen the following day just for routine examination and observation. Typically the patient has little or no pain, no swelling, or bruising, and in general, feels well. The patient is advised to resume all normal activities including normal daily hygiene, physical activities, regular diet, and regular sleep habits. The fast procedure is a highly successful procedure in the hands of expert doctors who specialize in this type of surgery.
Most patients are able to go home the same day with very little post-operative