Dr. Dayan Presents on Open vs. Closed Rhinoplasty: 4 of 7
Steven H. Dayan, MD, FACS, Chicago-based facial plastic surgeon, presents to the Australian Facial Plastic Surgery Society on the application of both the open and closed rhinoplasty approach.
Duration : 0:7:32
Rhinoplasty Operating Room Footage – Tip Cartilage Contouring (Nose Job)
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Join Rhinoplasty Specialist Dr. Paul Nassif, of Spalding Drive Cosmetic Surgery & Dermatology located in Beverly Hills, in the operating room as he performs Tip Cartilage Contouring.
Although techniques and methods employed during rhinoplasty surgeries are the same regardless of race, there are some trends that apply to patients of certain ethnic backgrounds.
East Asian patients often want their noses to appear narrower. This can be done through the use of infractures, where the nasal bones are broken and moved in or reset to thin out the nasal area and add projection in the process. Outfractures, where the nasal bones are broken and moved outwards, are used to widen a too-narrow dorsum. East Asian patients typically seek augmentation (adding material) of the bridge of their nose which will make the nose appear narrower as well. In Asia, patients typically use a variety of alloplastic implants including Gore-Tex, Med-Por, or silicone. Due to the risks of alloplastic materials, natural materials to the bridge of the nose, such as rib cartilage (costal cartilage) or ear cartilage (auricular cartilage) are being used more commonly.
Patients of African descent commonly seek narrowing of wide nostrils. This procedure may include removing sections of the base of the nostrils or sections of the nose where it meets the face. The tip of the nose can be restructured by removing tiny sections of cartilage to give the nose more shape, or even adding cartilage to provide additional structure to the nasal tip.
AFRICAN AMERICAN NASAL ANATOMY:
1. Skin: Thick, Abundant Fibrofatty tissue
2. Radix: Deep, Inferiorly-Set & Low
3. Nasal Bridge & Dorsum: Short Nasal Bones, Wide & Flat
4. Tip: Bulbous, Thick-Skinned, Under-Projected, Derotated (Ptotic), Abundant Nasal Soft Tissue, Broad Domes, Minimal Definition
5. Base: Wide, Thick, Horizontal & Flaring Nostrils
6. Nasolabial Junction: Retracted, Under-Developed Nasal Spine
7. Maxilla: Usually Retrusive & Hypoplastic
HISPANIC NASAL ANATOMY:
1. Skin: Thick, Abundant Sebaceous Glands
2. Radix: Low to Normal
3. Nasal Bridge: Wide
4. Dorsum: Convex (Nasal Hump)
5. Tip: Bulbous, Thick-Skinned, Under-Projected, Occasionally Derotated to Normal, Abundant Nasal Soft Tissue, Broad Wide Domes, Minimal Definition
6. Columella: Short to Normal
7. Base: Wide, Thick, Horizontal & Flaring Nostrils
8. Maxilla: Within Normal Limits
ASIAN NASAL ANATOMY:
1. Skin: Heavy, Thick & Sebaceous
2. Radix: Deep & Flat
3. Nasal Bridge & Dorsum: Low, Wide & Flat
4. Tip: Bulbous, Thick-Skinned, Under-Projected, Ptotic, Abundant Fibrofatty Tissue, Broad Domes, Minimal Definition
5. Columella: Short, Minimal Show (Retracted)
6. Base: Wide, Thick, Oblique & Flaring Nostrils
7. Maxilla: Usually Retrusive
DESIRED RHINOPLASTY GOALS:
1. Bridge: Moderately Thinner
2. Dorsum: Higher (Augmented)
3. Tip: Refined, Increased Projection, Increased Rotation
4. Base: Vertical-Oblique Nostrils & Triangular Nasal Base
5. Columella: Increased Columellar Show & Length
6. Maxilla: Less Retrusive
7. Skin-Soft Tissue Envelope: Moderate Thickness that Provides Good Tip Definition
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Duration : 0:1:34
Rhinoplasty Operating Room Footage – Turbinate Reduction (Nose Job)
http://www.rhinoplastyspecialist.com
Enter the operating room with Rhinoplasty Specialist Dr. Paul Nassif, a world-renowned expert in revision & ethnic rhinoplasty, as he performs a Turbinate Reduction. His practice, Spalding Drive Cosmetic Surgery & Dermatology, is located in Beverly Hills, CA.
In anatomy, a nasal concha (or turbinate) is a long, narrow and curled bone shelf (shaped like an elongated sea-shell) which protrudes into the breathing passage of the nose. Turbinate bone refers to any of the scrolled spongy bones of the nasal passages in humans and other vertebrates. [1]
In humans, the turbinates divide the nasal airway into three groove-like air passages and are responsible for forcing inhaled air to flow in a steady, regular pattern around the largest possible surface of cilia and climate controlling tissue.
It can be performed under a general anesthetic or with local anesthetic. Incisions are made inside the nostrils (closed rhinoplasty). Sometimes, a tiny, inconspicuous incision is also made across the columella, the bit of skin that separates the nostrils (open rhinoplasty). The surgeon first separates soft tissues of the nose from the underlying structures, then reshapes the cartilage and bone. Most people remain at home for a week. If there are external sutures, they are usually removed 4 to 5 days after surgery. The external cast is removed at one week. If there are internal stents, they are usually removed at four days to two weeks. The periorbital bruising usually lasts two weeks. Due to wound healing, there are minor and subtle shifting and settling of the nose over the first year.
In some cases, the surgeon may shape a small piece of the patient’s own cartilage or bone to strengthen or change the structure of the nose. Usually the cartilage is harvested from the septum although if there isn’t enough which can often occur in revision rhinoplasty, cartilage can be taken from the concha of the ear or rarely the ribs. In the rare case, again usually revision rhinoplasty, where bone is required, it is harvested from the cranium or ribs. Sometimes a synthetic implant may be used to reconstruct the nose. This is most common when augmenting the bridge of Asian noses.
Video Produced by Spore Medical
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Duration : 0:1:53
Operating Room Footage – Septoplasty for Rhinoplasty
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Septoplasty is a corrective surgical procedure done to straighten the nasal septum, the partition between the two nasal cavities. Ideally, the septum should run down the center of the nose. When it deviates into one of the cavities, it narrows that cavity and impedes airflow. Often the inferior turbinate on the opposite side enlarges, which is termed compensatory hypertrophy. Nasal obstructions caused by serious deviations frequently lead to chronic sinus problems. Turbinate reduction may also be advised to further enlarge the nasal cavities. If turbinate resection is indicated special care should be taken to avoid over-resection leading to Empty nose syndrome. Most surgeries are completed in 90 minutes or less, not including recovery time.
Every year, half a million people who are interested in improving the appearance of their nose seek a consultation with a Facial Plastic Surgeon. Some are unhappy with the nose they were born with, and some with the way aging has changed their nose. For others, breathing may be a problem, or an injury may have distorted the nose. A slight alteration of the nose can greatly improve ones appearance. Rhinoplasty (reshaping the nose), could improve ones looks, self-confidence or health. As with all facial plastic surgery, good health and realistic expectations are prerequisites.
The goal of rhinoplasty is to improve the nose aesthetically (without creating a surgical look) in order to create harmony with other facial features. Additionally, many patients have a chin augmentation in conjunction with rhinoplasty to create a better balance of features. Rhinoplasty is usually performed with local injections of anesthesia with intravenous sedation, or in some cases, under general anesthesia.In rhinoplasty, the majority of incisions are made inside the nose, where they are invisible. In some cases, an incision is made in the area of skin separating the nostrils. Certain amounts of bone and cartilage are then removed or rearranged to provide a newly shaped nose. If the patient has a deviated septum (cartilage and/or bone causing obstruction inside the nose), septal surgery, called septoplasty, is simultaneously performed. The incision is placed entirely inside the nose. The septoplasty removes portions of cartilage and/or bone that are causing the obstruction. The incisions are then closed with fine suture, followed by placement of a splint to the outside of the nose. The splint helps retain the new shape while the nose heals.
Duration : 0:1:37
Ethnic Rhinoplasty Surgery, My Experience with Dr. Nassif, Beverly Hills
http://www.rhinoplastyspecialist.com
Watch my experience from initial consult to final result as I have an ethnic rhinoplasty procedure performed by Dr. Paul S. Nassif of Spalding Drive Cosmetic Surgery & Dermatology located in Beverly Hills.
There where many procedures performed to get the incredible results I received including:
Deep Temporalis Fascia Harvesting
Septoplasty
Turbinate Reduction
Open Rhinoplasty
Nasal Smas Excicion
Vestibular Tissue Release
Tip Cartilage Contouring
Cephalic Trim
Columella Strut Placement
Shield Graft
Ear Cartilage Harvest
Rim Graft
Narrowing of Nasal Dorsum
The results are incediblle! It’s like a dream come true. I am so happy that I chose Dr. Paul S. Nassif as my surgeon. He is truely a gifted and wonderful surgeon.
Every year, half a million people who are interested in improving the appearance of their nose seek a consultation with a Facial Plastic Surgeon. Some are unhappy with the nose they were born with, and some with the way aging has changed their nose. For others, breathing may be a problem, or an injury may have distorted the nose. A slight alteration of the nose can greatly improve ones appearance. Rhinoplasty (reshaping the nose), could improve ones looks, self-confidence or health. As with all facial plastic surgery, good health and realistic expectations are prerequisites.
The goal of rhinoplasty is to improve the nose aesthetically (without creating a surgical look) in order to create harmony with other facial features. Additionally, many patients have a chin augmentation in conjunction with rhinoplasty to create a better balance of features. Rhinoplasty is usually performed with local injections of anesthesia with intravenous sedation, or in some cases, under general anesthesia.In rhinoplasty, the majority of incisions are made inside the nose, where they are invisible. In some cases, an incision is made in the area of skin separating the nostrils. Certain amounts of bone and cartilage are then removed or rearranged to provide a newly shaped nose. If the patient has a deviated septum (cartilage and/or bone causing obstruction inside the nose), septal surgery, called septoplasty, is simultaneously performed. The incision is placed entirely inside the nose. The septoplasty removes portions of cartilage and/or bone that are causing the obstruction. The incisions are then closed with fine suture, followed by placement of a splint to the outside of the nose. The splint helps retain the new shape while the nose heals.
Duration : 0:7:0