AESTHETICS
RHINOPLASTY
By Mr Ali Juma
Rhinoplasty Surgery dates back to ancient Egypt 3000-2500 BC . In India , Sushruta ~ 500BC described nose reconstruction , whilst in the Roman empire Celsus also described nasal reconstruction in 25BC .
In the 11th Century the Arab Abi Usaiba translated the Indian literature popularising the procedure more until the advent of the 16th Century when the Italian Tagliacozzi used the arm skin to reconstruct a fully amputated nose .
In the 18th Century artificial noses were made from metal . In the 20th Century Killian was one of the pioneers of nose surgery with many variations to follow over the years . Rhinoplasty is on the increase due to the Covid-19 pandemic increasing the use of digital media and videos in communication between people , which resulted in more self-awareness about body and face image .
The nomenclature of rhinoplasty is often used interchangeably in non-medical literature with nose job , and / or nose reshaping . Rhinoplasty / Septorhinoplasty objectives are to re-shape the nose , and in most patients to decrease the size of the nose ( reduction rhinoplasty ). In a smaller number of individuals , the procedure would be to increase the size of the nose ( augmentation rhinoplasty ). By design this surgery will alter the appearance of the nose tip , bridge , and nostrils in a controlled fashion with a pre-agreed surgical plan .
What is the difference between a Rhinoplasty and a Septorhinoplasty ?
A rhinoplasty involves dealing with the nose cartilage , bony skeleton , and soft tissue , without managing any problems involving the septum . The septum is the large cartilage that sits inside the nose cavity in the midline . However , if there are breathing problems , which often results due to deviation of the septum , then the two procedures are combined . This is when the procedure is termed Septorhinoplasty .
A rhinoplasty may be chosen by the patient for many reasons such as dislike of the size or shape of the nose due to inherited characteristics or to restore a flattened nose after an injury . As the nose is centrally positioned , and projects from the face it is considered by many people to be a focal point and is an important part of the face . It can impact on how people perceive themselves in the mirror and camera especially in a selfie . If someone is unhappy with the size or outline of their nose , they may wish to alter it to make them less self-conscious or to help self-esteem . It is not recommended until at least the age of eighteen unless there are specific indications to the contrary .
In assessing the nose , we apply the rules of thirds for the length of the nose relating to the face and the rule of fifths when considering the width of nose relative to the face in Caucasians , thus preserving the PHI golden ratio of beauty . We also assess the chin and the size of nose in addition to the tip of the nose relative to the upper lip . The function of the nose is an integral aspect of the assessment . When there is functional impact , in my practice , the surgery is usually carried out with an ENT colleague in a multidisciplinary fashion .
A very important component of the nose and how surgical outcome is perceived is the thickness of the skin . The thicker the skin the less visible the reduction of the nose is perceived , the thinner the nose skin the more likely imperfections may be seen , however , the more visible the cosmetic outcome is perceived .
Techniques are multitude ; however , they boil down to open and closed rhinoplasty techniques , with or without cartilage grafts . The cartilage grafts can be obtained from the septum , the ears , or the ribs . The rib cartilage is utilised for augmentation in the more severe cases , like following a saddle nose with collapse seen more commonly in boxers with multiple repeated injuries of the nose .
Joseph described the closed rhinoplasty in 1898 . Interestingly he was a German Orthopaedic surgeon . The surgical incisions in this technique are made inside the nose . The open technique will have
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