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    Rhinoplasty

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    Aesthetic Objectives

    Rhinoplasty is plastic surgery of the nose, that has the objective of reducing, augment, giving form to the point, the bridge or the nostrils, in order to achieve a natural looking nose that is in harmony and balanced with the proportions of the face.

    Noses are considered harmonious and pretty, when they look “natural”. Natural noses are those that are imperceptible to others and that at the same time help balance the face.

    Plastic surgery of the nose should be done with caution, to avoid snub (porky) noses or stigmatized (ethnic) noses.

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    Functional Objectives

    Functional corrections are prescribed for when the patient shows a difficulty in breathing due to a variation to the Septum, or an enlargement of the nostril wings.

    Once I am a Craniomaxillofacial surgeon, I have the necessary knowledge so that these functional corrections can be made at the same time as aesthetic rhinoplasty.

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    Candidates

    A rhinoplasty is indicated for persons who have a non-aesthetic disproportion of the nose in relation to the face, be it in size, shape or symmetry (such as divergence). Nasal deformities are normally due to a disproportion between the tip and the nose ridge.

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    Types of Noses – Anatomical Characteristics

    We can describe three main types of noses, each varying within each race type:

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    Caucasian Nose

    Characterized by the Italians, Greeks, Arabs, Spaniards, etc., in other words, descendants of white races. The nose ridge is high and protruding because of an excess in bone structures and cartilage. This type of nose normally has a downward point and thin skin.

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    Negroid Nose

    Is the characteristic of the black race and its descendants. It shows a low nose ridge with little bone structure or cartilage. This type of nose has a rounder tip, wider nose wings, and thicker, oilier skin.

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    Oriental Nose

    is the characteristic of the Asian races and its descendants. It also shows a low ridge similar to the Negroid Nose but with a longer tip. The disproportion between the nose tip and ridge is less observed than the Negroid Nose one.

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    Surgical Aspects

    The basic premise for a rhinoplasty, either for Caucasian, Negroid or oriental noses, is the establishment of the correct proportion between the nose ridge and the nose tip.

    Each nose has its unique properties that should be carefully identified by the plastic surgeon, so that a correct rhinoplasty approach can be made, while avoiding stigmatized results. Remember that we are talking about distances of millimeters that can mean either a successfully proportioned nose or something less.

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    Surgery

    CAUCASIAN NOSE

    The basic areas for the aesthetic correction of this type of nose are:

    • Lower the ridge, removing the excess bone structures and cartilage and remodeling the tip;
    • Shortening and elevating to the tip;
    • Correction to any misalignment of the septum, if the case requires;
    • Shortening of the underlying bones through controlled fractures, if the case requires;

    Liberation of the anchoring musculature of the tip, if the case requires.

    NEGROID NOSE

    Following the premise of creating a proportion between the nose ridge and the nose tip, the basic areas for the aesthetic correction of this type of nose are:

    • Elevate or augment the ridge with substances originating from the patient’s own body, such as bone or cartilage, or:
    • Using bio compatible materials such as Porex;
    • Defining of the nose tip through the remodeling of the cartilage structures found at the tip;
    • Shortening of the tip;
    • Correction of any misalignment of the septum, if the case requires;
    • Shortening of the underlying bones through controlled fractures, if the case arises;
    • Shortening the width between the nose wings through the removal of excess tissue and skin from the nose wings;

    Freeing of anchoring musculature at the tip of the nose, if the case requires it.

    ORIENTAL NOSE

    Basically presents the same types of alterations as the Negroid nose, but in a smaller degree.

    • Elevate or augment the ridge with substances originating from the patient’s own body, such as bone or cartilage. Or
    • Using bio compatible materials such as Porex;
    • Defining of the nose tip through the remodeling of the cartilage structures found at the tip;
    • Shortening of the tip;
    • Correction of any misalignment of the septum, if the case requires;
    • Shortening of the underlying bones through controlled fractures, if the case arises;
    • Shortening the width between the nose wings through the removal of excess tissue and skin from the nose wings;

    freeing of anchoring musculature at the tip of the nose, if the case requires it.

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    Incisions

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    1. The incisions are made through the inside of the nose, hiding the scars.
    2. Situations exist when it is necessary to create an incision at the base of the columella (the narrow strip of tissue that separates the nostrils), at the point where the skin begins to rise from the lip, so that one can have a direct view to treat the underlying structures. A scar will result at the point of incision but will normally evolve into a scar that is little apparent.
    3. When the indication is the removal of excess tissue from the nose wings, as is the case with Negroid and Oriental noses, there will be a scar at the point of incision at the base of the nose wings, but it too will evolve into a scar that is little apparent.
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    Anesthesia

    Local anesthesia associated with sedation, or general anesthesia. This depends on patient’s case.

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    Hospitalization

    With the advent of modern anesthetic techniques, patients normally return to their home on the same day.

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    Post–Operation

    After the conclusion of the surgery a gauze filling is placed inside each nostril to absorb any blood that may remain from the incision. These fillings are normally removed in 12 hours. When the treatment is for a deviated septum, the fillings may remain from 24 to 48 hours.

    To immobilize the nasal bones a bandage is also placed over the nose. This bandage is removed between 7 and 10 days.

    The new nose will be swollen immediately after the surgery, but this swelling will gradually disappear.

    Afterwards, flesh colored tape strip is placed on the nose for an additional 15 days period in order to better accommodate the nasal structures.

    The result will be final within six months.

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    Age

    Today, the concept of operating a nose only after 18 years of age has changed. With the evolution of techniques and delicate materials, it is possible to operate a person at 15 years of age, without any problem for nasal growth.

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    Computer Study

    There are some doctors who criticize the use of a computer manipulated photograph to demonstrate the possible result of a nose surgery, claiming that there cannot be a guarantee with anticipation how the nose operation will result. I have a different opinion. I am convinced that the image on the computer benefits the patient because it helps them to eliminate doubts regarding the shape of the nose that they would like to have.

    This is a benefit because the patient can see that the little lifted nose of a certain movie star, that they thought they wanted, may not look natural on their face. Each face has its own proportions and balance, and it is within these proportions that the new nose should be: in harmony and looking natural

    It has been now more than 10 years since I have used computer manipulated photographs on patients for rhinoplasty and other surgeries and so far, it has shown to be beneficial.

    Being absolutely transparent and clarifying that the computer manipulated photographs or the nose are only used as a reference, the patient understands that it is not possible to guarantee the final results.Through scientific honesty and professionalism from the plastic surgeon, there will not be any illusions or bad understandings.

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    Results

    • The nose when properly operated, will present a natural balance between the back and the tip, so that will fit harmoniously into the facial structure.
    • The result of a Rhinoplasty is practically definitive lifelong, but after age 60, can be altered in its form, because the changes of the skin associated with the aging process. However, this does not contraindicate rhinoplasty in a (a) patient age 40.
    • Serious professionals work to achieve their best results since each patient takes on his nose the signature of the surgeon. However plastic surgery is an inexact science and it can’t guarantee results. Each patient has their individual organic response and personal in which the physician has no power to interfere. Therefore, some patients have better results than others.
    • External agents such as sun, smoking, alcohol and drugs, among others, are factors that act negatively on the organic metabolism, interfering with the results.
    • Following the rules of the Federal Medical Council does not illustrate the results with before and after photos.
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    Profilometry – Relationship between the Nose and the Chin

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    The nose and the chin have a large relationship of proportions.

    The positioning of the chin, more to the front or more to the back, is of fundamental importance when determining the correct facial proportion.

    The chin should be touching a vertical line that passes through the base of the nose.

    The chin should be in proportion to the nose. Through experience, I have learned that sometimes a patient may complain that her nose is big but in reality it is the chin that is small. Making corrections by advancing the chin creates better harmony with the nose.

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    Contact us for more details…

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    Dr. Mariangela Santiago. – CRM 45138 states that this is a spontaneous and illustrative deposition procedure performed after medical consultation and indication of surgery and all medical and laboratory exams required as CFM’s recommendation.

    Even though this one was a successful case, no conclusion can be drawn based on this evidence, moreover, as in any case of plastic surgery, medical consultation with a Plastic Surgeon Specialist is required for making any decisions

    Following the rules of the Brazilian Federal Medical Council, to illustrate the results with photos made before and after procedures is not allowed.

    Dr. Mariângela Freitas Lima Santiago
    CRM-SP 45.138 (São Paulo Regional Medical Council)
    Plastic Surgery - RQE nº 11476 | General Surgery - RQE nº 7678

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