December 25, 2012

5 Most Common Rhinoplasty Limitations

Angie Buonassisi
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5 Most Common Rhinoplasty LimitationsThere is a world of possibilities when it comes to the kinds of changes that can be made to your nose, from reducing a hanging columella, to refining the nasal tip to reducing a large hump. When consulted properly, patients are typically thrilled with their results. However, setting expectations is harder than it sounds. Rhinoplasty specialists spend years mastering both their rhinoplasty surgery skills and their consulting skills. A key part of the discussion with your surgeon during your consultation should be the limitations of what is possible with your rhinoplasty, given your existing facial and nasal features.Here are 5 of the most common limitations to rhinoplasty surgery - be sure that you are clear on what you should expect before you decide to proceed.Thick SkinIt is very common to have thick skin and many patients who do undergo successfulnose jobs. Thick skin presents a challenge if the patient's main objective istip refinement. Thick skin prevents even the mostdrastictip refinement manoeuvresfrom creating a visible change that can actually be seen through the skin.Setting proper expectations with thick skinned patients usually involves discussing the degree of change that is possible, followed by the patient deciding if there is a large enough benefit to having surgery. Computer imaging plus a review of before and after photos of patients who have had similar changes - areinvaluableduring this discussion. For patients who do decide to proceed with surgery, I will discuss using one of the more dramatic tip refinementtechniquessuch asdome division.Thin SkinThin skinned patients can have nasal features that are overly angular or harsh. In these patients, even the most subtle surgicalmanoeuvres used to modify thecartilageand bone may be seen through the thin skin after surgery. Generally speaking, minute irregularities are not a concern for a patient unless they are focused on having a "perfect" nose after surgery. Patients seeking perfection are not typically good candidates for rhinoplasty - but it is the responsibility of their surgeon to set their expectations properly.Consultations with thin skinned patients should include a discussion of the possibility of visible (usually very minor and difficult to see) irregularities being seen through the skin after surgery. If the patient can accept the limitations of their thin skin and decides to proceed with surgery, I select the most conservative surgical techniques in order to minimize the changes of visible irregularities. For example I would usedomescoringordome defining suturesrather than dome division. I often also recommend spreader grafts aftersignificanthump reduction to help camouflage irregularities.Twisted NoseTwisted noses are very difficult to fix. It is reasonable to expect an improvement, but not a total correction. Find out more aboutwhy a twisted nose can't be fixed.Augmentation LimitationsPatients of Asian decent often request that the bridge or tip of their nose be augmented. A certain degree of augmentation certainly is possible. However the skin can only stretch so much. Augmentation in thick skinned patients with soft nasal cartilages isparticularlydifficult. An honest conversation between the surgeon and the patient about what degree of augmentation is possible - is essential.Dramatic Improvements in a Revision RhinoplastyScar tissue and surgically modified nasal anatomy limit what is possible with revision surgery. Minor changes are more feasible that dramatic ones. In addition, there are risks to revision surgery, such as the possibility of the skin tearing during the surgery. Be sure that your surgeon discusses the limitations and risks of your revision surgery.A Consultation with a Rhinoplasty Expert Is KeyExpert rhinoplasty surgeons will use a variety of consulting tools to help you determine if rhinoplasty is right for you. If you live in Vancouver or plan to travel here for surgery, you can request a consultation with Dr. Buonassisi, or have a complementary telephone consultation with a patient care expert. We will often ask for your photos to help best assess what is possible.Related resources

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