Double board-certified Facial Plastic Surgeon Dr. Sang W. Kim of the Natural Face™ Clinics, provide cosmetic rhinoplasty, or nose surgery, for patients residing in the Syracuse metropolitan area and Central New York area including Ithaca and Rochester.
What Is Cosmetic Rhinoplasty?
Rhinoplasty, also called “nose surgery”, is one of the most challenging facial surgeries to do well. Cosmetic rhinoplasty refers to nose surgery where the goal is to enhance the appearance of the nose. The aesthetic goal of rhinoplasty should be to achieve refined features of the nose that will harmonize the rest of your face.
There are three key elements that the surgeon evaluates during the initial consultation for cosmetic rhinoplasty.
First, the nose is more than just an external structure – it has a function to move the air through the nose. And unfortunately, often times making the nose appear “prettier” and “more refined” can mean a weaker and collapsible nose that may cause nasal airway obstruction. Comprehensive evaluation of the aesthetic and the function of the nose should be an essential step for every rhinoplasty case.
Second, the nose must withstand the test of time. Like the rest of the face, the nose undergoes change with aging. A nose with perfect proportion a year after rhinoplasty may undergo ongoing change over the years and become the unnatural and operated-looking nose. The key is to preserve adequate structural integrity to withstand the test of time.
Third, the goal of cosmetic rhinoplasty should be tailored individually based on the wishes of the patient as well as the other facial features of the patient. This includes the shape of the patient’s face, eyes, chin projection as well as the texture of the patient’s skin.
Tip of the Nose
Refining the nasal tip requires intricate balance of shaving or adding support to the underlying cartilaginous framework that shapes the tip of the nose.
Each individual patient brings their own set of variables ranging from the thickness of skin and soft tissue enveloping the nasal tip, to the integrity and shape of the cartilage underneath the nasal tip.
Modern perspective in cosmetic rhinoplasty- restoring the tip support
Traditionally, cosmetic rhinoplasty focused on reductive technique – shaving or cutting the tip cartilage to refine or reshape the tip of the nose. Through the experience of past plastic surgeons we now know that the traditional reductive rhinoplasty can sometimes result in unpredictable and undesirable long term outcome.
Modern principles in cosmetic rhinoplasty consist of reinforcing the supportive structure of the nasal tip. Every changes made to the nasal tip will destabilize the tip support mechanism to some degree, and therefore must be countered with a reinforcing supportive maneuver.
Planning and execution of numerous techniques to refine the nasal tip depend on the individual patient. As aforementioned, shape and strength of the nasal cartilage, thickness of the skin and soft tissue will dictate which techniques – suture technique, reshaping of the cartilage, or addition of cartilage grafts – are necessary to achieve the desired outcome which will stand the test of time. This approach will also help prevent unforeseen complication of rhinoplasty – functional problem of the nose.
What to expect on your consultation day
We will ask you to specify what features of the nose you would like to improve. Dr. Kim will carefully examine both the inside and outside of the nose. He will then explain the underlying structural causes for the appearance of your nose, and how he will correct those problems from the surgeon’s perspective. We will also review the post operative recovery course and instruction. After the consultation, a set of photos will be taken, and we will create a set of digitally morphed photos simulating the surgical changes for you to ensure we understand your goal.
CASE STUDIES – COSMETIC RHINOPLASTY
Surgeon: Sang W Kim, MD
Equipment: Canon EOS T3i 1/160 F10 ISO Auto / 1600-3200 on EFS 18-55 lens
Case 1
1. Large nose
2. Hump
3. Drooping nasal tip
4. Bulbous nasal tip
Technique: Open approach rhinoplasty exposure with small inverted-V incision under the nose. Careful reduction of the hump involving excision and shaving of the bone and cartilage. Refinement of the nasal tip cartilage through shaving and suturing techniques. Shield graft and columellar graft from septal cartilage to re-establish ideal tip projection and rotation. This also enhances the tip support for long-term stability.
Case 2
1. Hump on the nose
Technique:
Endonasal approach requires a small incisions placed inside the nose only. As requested by the patient, conservative removal of bony hump was performed to soften the profile view without creating the over-done, downward sloped nose.
Case 3
1. Bulbous tip on Asian nose
Technique:
Endonasal approach requires small incisions placed inside the nose only. The patient has tendency to form scars, and wished to not have any external incision. Conservative narrowing of the nasal wall through precision cut of the nasal bone. Refinement of the nasal tip cartilage through shaving and suturing techniques. Placement of columellar graft from septal cartilage to establish the tip projection
Case 4
1. Large nose, “tension nose”
2. Drooping nasal tip
3. Hanging columella
4. Hump, which looks more prominent due to droopy nose
5. Strong convex nasal tip
Technique:
Open approach rhinoplasty exposure with small inverted-V incision under the nose.
Shield graft from septal cartilage to refine the nasal tip
Further refinement of the nasal tip cartilage through shaving and suturing techniques.
Reshaping of the caudal septum to correct the hanging columella
Tongue-in-groove technique to re-establish ideal tip projection and rotation.
Once rotation has been corrected, actual hump was minimal. Conservative reduction of the hump refinement.
Case 5
1. Broad nasal bones
2. Asymmetric nasal tip
Technique:
Open approach rhinoplasty exposure with small inverted-V incision under the nose.
Shaving of the bony hump
Careful cut along the nasal bone to narrow the middle segment of the nose.
Refinement of the nasal tip cartilage through shaving and suturing techniques.
Case 6
1. Over projected nose
2. Strong convex nasal tip
Technique:
Open approach rhinoplasty exposure with small inverted-V incision under the nose.
Correction of the anterior septum
Shaving of small bony hump
Vertical dome division to correct strong convex nasal tip, reduce the projection of the nasal tip.
Further refinement of the nasal tip cartilage through shaving and suturing techniques.
Tongue-in-groove technique to re-establish ideal tip projection and rotation and stabilize. This also enhances the tip support for long-term stability.