Dr. Bared speaking the Correction of the Crooked Nose
Correction of the crooked nose is considered the most challenging deformity in rhinoplasty. Recently Dr. Bared was an invited expert speaker for the 31st annual American Academy of Cosmteic Surgery meeting in New Orleans. Dr. Bared was asked to speak about his expertise in the field of rhinoplasty to other cosmetic surgeons. The main take-home point which Dr. Bared conveyed to the other surgeons was that there are no short cuts to the correction of the crooked nose.
What makes the correction of the crooked nose so challenging?
The crooked nose is considered one of the more challenging corrections to make in rhinoplasty surgery. What makes the procedure so challenging is the little room for “error.” It is not to say that the lack of correction is an error but rather there is very little room when trying to correct the crooked nose—every millimeter counts. As a surgeon, you are trying to set a three dimensional structure in the center of the face in the midline.
Assessment and proper analysis
Dr. Bared feels that a successful surgery “starts” with the pre-operative assessment. During the initial consultation a detailed history and physical examination needs to be performed. Proper history should include asking as assessing for nasal breathing problems. Is the breathing issue a fixed problem on one side? Does it affect both sides? Does it fluctuate? What makes it better, if anything? After taking the proper nasal history, Dr. Bared then performs a thorough nasal examination which includes the evaluation of the septum and the nasal valve. The nasal examination often includes the use of an endoscope to thoroughly examine the septum. Dr. Bared stressed during his talk that attention needs to be apyed to the area of the nasal valve. The area of the internal nasal valve is an area where the maximum restriction to airflow takes place. It is bordered by the septum, the nasal sidewall and the inferior turbinate. Dr. Bared explained that if each of these areas is not properly examined a component of the nasal airway may not be addressed during surgery. Dr. Bared went on to explain that proper nasal analysis also includes the taking of photos of the nose from multiple angles and close-up photos.
After a patient is seen in consultation, examined, and photos are taken, the surgeon should then develop an operative plan. Dr. Bared explained that the initial plan is based on the evaluation of these factors. The plan may change within the surgery if the anatomy of the bones and cartilages are different than what was expected. The surgeon needs to have a ‘toolbox’ of techniques available in order to make the adequate corrections. The correction of the crooked nose typically entails using cartilage grafts made available by the cartilage from the septum. The use of cartilage grafts and suturing techniques help to make the corrections to the crooked appearance of the nose.
The correction of the crooked nose does not end at the time of surgery. The follow up appointments with the surgeon are very important and will affect the ultimate outcome. There are techniques that can be employed after the surgery to help make refinements to the results.