Nasal tip contouring is one of the more challenging aspects of rhinoplasty. It requires the precise alignment and orientation of the tip cartilages to provide an aesthetically pleasing result. Importantly, the maneuvers employed need to provide for long term tip stability and results. After a rhinoplasty is performed, like any other surgery, the body heals itself through scarring. It is important that the techniques employed in the rhinoplasty procedure can help to withstand these contractile forces so that the tip results do not change with time.
Creating tip stability
The goal in creating tip stability is to attempt to limit unknown variables after surgery. As there exist many variables with rhinoplasty: the existing anatomy of the cartilages, the thickness of the skin, and how the skin heals after surgery. Dr. Bared’s goal as a rhinoplasty surgeon is to attempt to control as many variables as possible with the goal of creating predictable results. As a rhinoplasty surgeon we only have so much control over the healing of the nose. If left unchecked or not secured we add even more variables to the results. If the tip is not stabilized, the nose may look a certain way during surgery only to change in shape or become crooked in time as it heals. At times, these apparent changes may not happen for years after a rhinoplasty. Therefore, Dr. Bared feels it to be imperative that he does his part in attempting to prevent any unwanted changes after surgery. Even with the most modern techniques in tip stability the tip may change in appearance depending on how the individual heals. Dr. Bared employs techniques which include minimal cartilage removal and creating a strong foundation to help counteract the forces of healing. He uses grafts such as extension grafts to create a solid foundation. An extension graft is a type of graft from which cartilage is taken from the septum and used to support the tip cartilages. In this way the tip cartilages have a strong support and are able to withstand the forces of healing and contraction.
Creating tip shape and tip refinements
After the base of the tip has been adequately supported, the tip cartilages then can be refined to create the desired tip shape and outcome. It is important when re-contouring the tip cartilages that they remain anatomically intact in key areas to prevent nasal wall collapse and breathing obstruction. There exist certain areas of the cartilages that need to remain intact to prevent the compromise of unobstructed breathing. The tip can be refined and made smaller without the need to overly remove the tip cartilages. Tip refinements can be accomplished with the placement of sutures in key areas, removal of a certain amount of cartilage in other key areas, and finally through the use of tip grafts when needed.
Recovery from a Rhinoplasty procedure
The follow up after a rhinoplasty is very important. Patients tend to be under the misunderstanding that the surgery alone is all that is needed to achieve their aesthetic goals. However, there are things which can be done in the post-operative period to help “mold” the results. Dr. Bared stresses the importance of follow up to all his patients as being critical to the ultimate outcome. Dr. Bared may often start small injections of steroids about a month after surgery to help with any areas of swelling or asymmetries. Also, nasal pressure maneuvers and sometimes taping can be employed to help with the swelling. The tip is the very last area of the nose to go down in size after surgery. The swelling dissipating from the nose is gravity dependent and as the tip is the most dependent area it is the last to decrease in size.