Nose jobs techniques | Open nose jobs, Closed nose jobs, Incisions, Cartilage grafting, & Osteotomies

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Dr. Sam Naficy has been awarded the "Patients' Choice Award" by - a website dedicated to rating the quality of physicians across the country. Out of 720,000 physicians, only 5% received this honor.

Nose Job Surgery

Nose job surgery techniques have evolved a great deal over last 2-3 decades. When nose jobs were a young specialty, nose job techniques were more crude and primarily involved removal of cartilage and bone. This technique of reduction nose jobs worked well in some types of noses but had poor outcomes with others. The weakening of the structural support of the nose would often result in collapse or undesired shape or asymmetries, not to mention nasal obstruction.

Gradually there was a shift toward a more conservative removal or excess cartilage and bone coupled by reshaping (as opposed to removal) of the structures that were left behind, thus removing less and preserving more structure.

Advanced nose job techniques today involve reshaping of the nose while maintaining structural integrity. Nose job results are more predictable and more natural and there are much less long-term breathing issues than there were 20 years ago.

Incisions: open nose jobs vs. closed nose jobs

The difference between the incisions in open vs. closed nose job is quite minimal. Both open nose job and closed nose job involve incisions inside the nose. Open nose job has a small component that crossed between the nostrils.

Closed nose job incisions (left) compared with Open nose job incisions (right)

The main advantage of open nose job is that is allows the surgeon to see the anatomy of the nose very well and to be able to do a more precise job during the nose job procedure. The vast majority of experienced nose job surgeons today use the open rhinoplasty approach.

The main advantage of the closed nose job is that there is less swelling and numbness of the tip after surgery. The closed nose job technique however is decreasing in popularity since modern nose job techniques demand a better ability to see the nose than is possible with the closed nose job technique.

Incisions: when are incisions made on the sides of the nose?

Incisions along the sides of the nostrils are necessary in nose jobs when the nostrils are wide and flaring and need to be reduced in size. This technique is called alar base excision and the resulting incision falls in the groove under the nostril.

African American nose job patient with flaring nostrils before (left) and after open nose job with alar base excision (right)

how is cartilage removed?

When there is excess cartilage in the nose it can be removed during a nose job using precise instruments. Since cartilage is the main structural framework of the nose, as excess cartilage is removed during a nose job it is necessary to leave behind enough support to avoid problems with nasal obstruction, collapse, or pinching.

How is cartilage RESHAPED?

During a nose job, cartilages of the tip of the nose are reshaped using a variety of suturing techniques. Tip suturing techniques can turn a round, and bulbous tip into a more defined and sculpted tip. It can also help reduce the width of the tip of the nose and can help correct tip asymmetry. Tip suturing also allows correction of a droopy nose or an excessively up-turned nose.

What is cartilage grafting and why is it needed?

Grafting is a term used to describe transfer of cartilage from one place to another place during a nose job. The most common types of grafting material in nose jobs include cartilage from the septum, sometimes form the ear, and rarely from the rib. Grafting of some kind is very common during nose jobs and most advanced nose job techniques used today involve grafting of the cartilage removed during a nose job or septoplasty. Some of the more common types of grafts used during nose jobs are columellar strut grafts, alar batten grafts, alar strut grafts, spreader grafts, and tip grafts.

How is bone reshaped

During nose jobs the nasal bones are reduced using rasps and files. Typically minor changes in the shape and size of the bones can be achieved using rasps and files. More dramatic changes in the shape and width of the nasal bones are achieved by a technique called osteotomies (controlled fracture of the nasal bones). During an osteotomy, multiple small perforations (holes) are made along the desired line of fracture or break and with manual pressure, the nasal bones can be pushed in to effectively narrow the width of the bony portion of the nose.

Is there packing placed inside the nose?

Dr. Naficy does not use packing inside the nose after a nose job. This is very much appreciated by his patients since they can breathe through their nose immediately after surgery and there is considerably less pain when no packing is placed inside the nose.

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