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Rhinoplasty Approaches

Los Angeles is home to millions of noses, and hence, thousands of nose-jobs (or rhinoplasties). Noses come in many sizes and shapes. Some small, some big, some wide, and som “pinched’. In Beverly Hills, one would think that the main function of the nose is to provide rest for Gucci sunglasses. But the nose is much, much more than a designer sunglass holder (off Rodeo Drive, anyway). But everywhere, noses are the centerpiece of the face. Some noses infrastructure make breath difficult. Rhinoplasty is surgery of the nose, either for cosmetic improvement of corrective breathing. It is a surgery of SUB-millimeters. Small changes make a BIG difference! When we look at the nose, we consider its units: dorsum, side walls, tip, ala (part around the nostril), columella (part between the nostrils), and its shape: big, wide, bulbous tip, etc. Depending on the ‘problem’, the nose can be approached surgically either ‘closed’, meaning incisions are hidden within the nasal pasage, or ‘open’, meaning that the nose is approached with an incision over the columella. I approach noses either open or closed depending on the surgical plan of its units. Generally, when the tip needs work, open approaches offer an advantage of better visibility and exposure to the tip. However, it can leave a tiny scar (usually not visible at conversation distance) on the columella and longer tip swelling. The closed approach is best reserved for noses that need little to no tip work. And the swelling is less significant. Today in the office, I saw a patient who asked some very good questions about her upcoming rhinoplasty. And it reminded me that patients are more informed than ever! Perhaps from too many late night blogs by bored plastic surgeons?

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