Plastic Surgery Articles

To some degree, rhinoplasty surgery (nose augmentation or enhancement) is the procedure that started the consumer revolution in cosmetic plastic surgery.  For some years it was the most popular procedure among Americans – before facial lifts became a little more natural, before Botox was introduced and before breast augmentation became a mainstream choice for women.

Rhinoplasty continues to be a popular form of cosmetic plastic surgery for which surgeons have developed some interesting techniques in recent years.  Many rhinoplasty procedures are performed on non-Caucasian individuals, and in those cases the surgery is often primarily for the purpose of reshaping the nose.  Nose reduction involves shaving and reshaping existing nose cartilage.  For nose augmentation however, an implant of some sort is going to be necessary.  Some cosmetic plastic surgeons have used silicon implants to reshape and augment noses.  That substance has proven to be less than ideal, as it can harden and become wobbly atop the bridge of the nose.

Frozen Bone Implants
Cartilage grafts have been widely used, with cartilage harvested from some other portion of the patient’s body such as the ear, rib cage or septum.  Some cosmetic surgeons will opt for bone transplants from the cranial area.  All of these choices have potential downside in the form of possible rejection of the graft as well as compromising or scarring that portion of the body from which the grafting material is taken.

A recent innovation has been the use of freeze-dried and frozen bone to straighten a misshapen nose bridge as well as augment it.  The material used is held by tissue banks in frozen form and called allograft. It’s a technique that has shown early success among a test group and holds out hope for a new replacement for the artificial implant materials used by many cosmetic plastic surgeons.

Scarless Surgery
Plastic surgeons have debated for years over the question of which rhinoplasty technique is better: open or closed? All rhinoplasty procedures involve incisions within the nasal cavities.  Closed rhinoplasty is a technique that uses only those inner incisions to perform the procedure, leaving no incisions or scarring on the outside of the nose.  Open rhinoplasty includes an incision across the flesh between the nostrils, on an area called the columella.

With a columella incision, the surgeon can lift the skin covering the nose for better access.  The closed method avoids scarring the small area between nostrils.  While the columella incision may leave a barely discernable scar, that is not always the case.  Another option to the columella incision is a cut along the line where the nose meets the cheek. This incision will heal to be virtually imperceptible; thus the choice of closed rhinoplasty or open rhinoplasty involving the nose/cheek incision is known as “scarless surgery.”

Ethnic Rhinoplasty
Cosmetic plastic surgeons have found great interest in rhinoplasty from African Americans, from Hispanics and from some Asians, all of whom often grow to adulthood with somewhat flattened, wide noses.  Most of these patients would like a nose with a more pronounced tip and one that is defined by its wide base.  It’s a delicate balancing act to perform rhinoplasty on a member of these ethnic groups and give them the new features they are seeking while retaining the ethnic identity of the face as a whole. 

Creating a reproduction of an Anglo movie star’s nose on a person of color can easily create a face with mismatched characteristics and a miserable social situation for the patient.  Surgeons who specialize in ethnic rhinoplasty will typically seek to graft a more pronounced tip into the nose along with perhaps narrowing the bridge.  The second step is narrowing the nostrils to conform to the newly elevated and tipped bridge. 

All of this constitutes a major change in physiognomy that hopefully will make the patient happy while not drawing stares from peers or members of his/her ethnic community.  As our country grows more ethnically diverse, so does the demographics of our middle class, for whom cosmetic plastic surgery has recently become a viable option.