Questions and Answers

What is an alar-plasty?

Some patients have excessively wide nostrils which require narrowing in order to bring all the components of the nose into balance. When patients have wide nostrils, an alar-plasty is performed to narrow them. This involves removal of a wedge of skin at the base of the nostrils and sewing them closer together to narrow the base of the nose. It is also possible to release the lateral restraining ligaments of the nostrils which decreases the widening effect when smiling dynamically. This can be performed as a stand-alone procedure, or in conjunction with a full rhinoplasty.

How is a dorsal hump removal performed?

The dorsal hump is composed of both bone and cartilage and must be shaved down in order to remove it. The cartilaginous component of the hump is cut with a knife or scissors, while the bony component is cut with an osteotome. Once the hump has been surgically removed, then a rasp is used to file down any irregularities across the bridge line. Once the bridge line has been smoothed to a new appropriate profile, then osteotomies will be required to close the open roof deformity created from the hump removal itself.

Why is important to break the nasal bones during a nose job procedure?

Osteotomies placed in the nasal bones are mandatory once the dorsal hump has been removed. The osteotomies close the open roof, flat-top nasal deformity created from the hump removal itself. Osteotomies are also necessary to narrow wide nasal bones present. Medial and low lateral osteotomies are performed to accomplish improvement in the upper two thirds of the nose.

Why are spreader grafts used during a rhinoplasty?

Spreader grafts are composed of the patient’s own cartilage harvested from inside the nose. They are cut to length and then fashioned for width and are placed in the mid portion of the nose above the nasal tip to prevent the upper lateral cartilages from collapsing in the mid portion of the nose. When patients have an hourglass appearance from the frontal profile, it also improves the dorsal aesthetic lines. The spreader grafts also prevent the upper lateral cartilages from collapsing after the hump has been removed.

How to reduce the bulbous nasal tip?

The wide and bulbous nasal tip can be caused from wide nasal tip cartilages, or thick skin. A rhinoplasty procedure can only accomplish improvement and narrowing of the wide nasal tip cartilages. These are called the lower lateral cartilages of the nasal tip. Suture techniques consisting of inter-domal and intra-domal dissolvable sutures are performed to narrow the nasal tip cartilages when there is a wide and boxy nasal tip. Conservative cartilage removal can also be performed as well. Thick Skin in the tip of the nose prevents refinement in that area, so it is important to have realistic expectations with your rhinoplasty in the nasal tip area. It is not possible to thin the skin in the nasal tip.

What is the difference between a septoplasty and rhinoplasty?

A functional septoplasty does not change the shape of the nose, while a cosmetic rhinoplasty does. A septoplasty is performed in the back of the nose to improve airflow when there is a deviated septum present. The deviation of the nasal septum creates airflow resistance and can be symptomatic. Some patients actually have a bone spur in the back of the nose which can cause headaches and nasal obstruction. A septoplasty can be billed to the patient’s medical insurance once medical necessity has been documented and preauthorization has occurred. Anticipate deductibles and co-pays associated with your medical insurance. A cosmetic rhinoplasty is performed to change the shape of the nose such as straightening the crooked nose, shaving down the dorsal hump, reducing the bulbous tip or hanging columella. Expect to pay for the cosmetic rhinoplasty yourself. Both a functional septoplasty and cosmetic rhinoplasty can be performed together under one anesthesia with one recovery period.

How does a rhinoplasty surgeon straighten the crooked nose?

There are many components in the nose that can create asymmetry and a crooked nose. When the nasal bones are crooked, medial and lateral osteotomies are performed in the nasal bones themselves to straighten the top portion of the nose. The middle portion of the nose can be straightened as well when there is a concave upper lateral cartilage in the mid-vault. A spreader graft composed of the patient’s own cartilages is usually placed in that area to match the concave side to the opposite side. When the nasal tip cartilages are asymmetrical, then cartilage can be removed on the convex side and cartilage grafting techniques are performed on the more concave side in the nasal tip itself. A columella-plasty is performed when the columella itself is crooked.

Why are steroid shots important for patients with thick skin after a rhinoplasty procedure?

Steroid shots are very important for patients who have thick skin after rhinoplasty procedure to prevent a poly-beak deformity. Patients who have thick skin tend to retain more fluid in the supratip portion of the nose which blunts the effects of the rhinoplasty procedure itself in the nasal tip. The steroid shots are beneficial to reduce edema and swelling in that area for the first few months after the procedure. It is very important to follow up with your operative surgeon to monitor the healing process. In addition, a low salt diet and Blenderm taping are also important to reduce swelling in that area after the rhinoplasty surgery.

How does a rhinoplasty surgery lift the droopy tip?

The droopy tip can be caused from a downwardly pointing nasal tip cartilages, a dorsal hump and poor tip support. A rhinoplasty procedure can accomplish shaving down the dorsal hump, lifting the nasal tip cartilages, and sometimes a cartilaginous graft is necessary to support the tip itself. When patients have a dynamically drooping nasal tip, it’s important to release the depressor septi ligament which pulls the tip down dynamically when smiling. Once this ligament has been released, the nasal tip will no longer droop when smiling and talking.


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    The Seattle Rhinoplasty Center

    William A. Portuese, M.D.
    The Seattle Rhinoplasty Center®

    Seattle, Washington 98104

    (206) 624-6200

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