The patient was in her mid thirties and complained of the decreased ability to breathe through both sides of her nose. She also thought her nose was way too large for her face. She wanted to have a cosmetic rhinoplasty and have the breathing issues worked on at the same time. She noted a lot of width to the lower part of her nose including the nasal tip. She also felt that her nasal tip drooped.
Facial Plastic Surgery Analysis
On examination, the patient had a deviated septum which blocked both air passages. The deviation was totally internal and not evident cosmetically. She also had enlarged turbinate bones which also blocked her airway.
In terms of cosmetic issues, the patient had a large bump within the upper bridge area and a wide middle third of the nose towards the tip. Additionally, the tip was very wide and boxy. In terms of tip rotation, the angle between the upper lip and the horizontal line across the tip on side view was 100 degrees, i.e. relatively upturned.
Cosmetic and Functional Results
The patient was pleased with her cosmetic and functional (breathing) results. She had wanted a slope to the nasal bridge and felt the amount of “bump” removed achieved that and made her nose much smaller. At her surgery, the breathing issues were addressed by performing a septoplasty to remove the deviated cartilage that was blocking her airway. Her turbinate bones were also reduced to open the airway. While the bump was being reduced, cartilage from the septum was used to strengthen the sides of the nose to keep the airway open. These are referred to as spreader grafts and one is used for each side. They are often used to provide new support to keep the nasal airway open when, as in this patient, there is a wide lower bridge.
With regards to the tip, at her rhinoplasty, the tip was recessed and narrowed but the rotation of the tip was no changed. This helped to retain the beauty of the lower third of the nose and decreased the chance for nostril show.
Rhinoplasty Cost
Patients are often concerned about “nose job” cost. The differing types of surgery have different prices but it’s important to remember that the nose is a small part of the body and thus, operating times, especially for closed rhinoplasty are relatively short resulting in a lower cost to the patient than most other procedures.
