What Is The Definition Of Advanced Rhinoplasty?

Nasal tip aesthetics is a rhinoplasty that aims to change only the mobile and lower part of the nose.

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What Is The Definition Of Advanced Rhinoplasty?

Nasal tip aesthetics is a rhinoplasty that aims to change only the mobile and lower part of the nose.

The main demands on the tip of the nose are:

• The tip of the nose is too broad, ill-defined.
• A droopy nose tip that goes down when smiling or talking.
• Extremely protruding nasal tip, very prominent and imposing.
• The tip of the nose is curved, asymmetrical.
• If the tip of the nose is too raised, it reveals the nostrils.
• It is the protrusion of the nasal cartilages under the skin, creating a relief under the skin of the tip of the nose.

What Are The Pre-surgery Stages Of Advanced Rhinoplasty?

Preoperative consultation and examinations for advanced rhinoplasty are the same as for cosmetic rhinoplasty.

How Is Advanced Rhinoplasty Done?

procedure

• hospitalization:
  • You should arrive about two hours before the start of the procedure.
• anesthesia
  • General anesthesia.
• Drawings :
  • Preoperative markers with sterile felt place surgical markers.
• Infiltration:
  • In order to facilitate the operation, anti-bleeding and pain-relieving serum is injected into the entire nose, making it painless and non-bleeding.
• Exhibition :
  • Cartilaginous structures are separated from soft tissues, namely skin, muscles, and mucous membranes.
• Surgical gestures:
  • Surgical gestures differ according to the necessary modifications.
  • The following paragraphs describe the technical movements according to the changes to be made.

What should be done for noses that are too long or have low tips?

There are 3 different techniques that can be used to lift the tip of the nose:

• “Tongue Groove” consisting of suturing mnesial growths with 3 U-shaped sutures weighing 4.0 in the caudal part of the septum.
• “Sideplay”, which consists of moving the intermediate growths towards the cephalic part of the alar cartilages. Traditionally said to be 1 millimeter of displacement, raising the tip 4 degrees. It is also necessary to treat the increase in the length of mnesial growths with a concomitant overlap.
• Septal shortening involving resection of the caudal portion of the cartilage septum.

What should be done for wide nose tips?

There are 3 possible actions that can be associated with each other to correct the tip of the nose:

• Remove the upper part of the lateral crus, taking care to leave at least 7 millimeters wide. This resection is not recommended for men.
• Suture the intermediate growths using intra and interdomal sutures, taking care to maintain a 90 degree angle between the 2 domes.
• Remove the hypodermic tissues, that is, the fat and muscle tissues under the skin of the tip of the nose. This technique is reserved for people with thick skin.

What to do for vague or swollen nose tips?

• To improve the definition of the tip of the nose, it is necessary to create both a solid support and a polygonal or diamond-shaped cartilaginous structure:
  • The polygonal or diamond-shaped structure is achieved with intra and interdomal sutures described by surgeons Rollin Daniel and Barış Kakır.
• There are 3 possible techniques to create nasal tip support:
  • “Tongue in Groove” consists of suturing mnesial growths with 3 U-shaped sutures weighing 4.0 in the caudal part of the septum.
  • The septal extension graft consists of applying a cartilage plate to the caudal part of the septum to lengthen it and applying Tongue in Groove over the septal extension graft.
  • Columellar support consists of positioning a central cartilaginous column between the 2 mnesial growths descending into the nasal spine.

How to take the tip of the nose too far back and forth?

• In order to move the tip of the nose backwards or protrude, it is necessary to act according to the supports at the tip of the nose and reduce the length of the alar cartilages:
  • Actions on peak supports:
    • It is drawn from the dorsal nasal pyramid, namely the septum and triangular cartilages.
    • Exersis of the Pitanguy ligament.
    • Opening the scroll ligament.
  • Reduce the length of the alar cartilages:
    • Reduction in the length of the lateral crus by performing an overlap.
    • Reduction in the length of mnesial growths by performing an overlap.
• Reduce the length of the nostrils by resecting the nostril feet.

How to increase the projection of the tip of the nose?

• To increase the protrusion of the nose tip:
  • It should be supported as in 1° Create nose tip support paragraph .
  • 2° should be defined as in the paragraph “How to draw the tip of the nose properly”.
  • It is possible to add 3° Cartilage grafts, especially apposition tip grafts of the Peck graft and Sheen graft type.

How is the small pit in the middle of the tip of the nose treated?

• Several movements are possible to remove a small hollow in the middle of the cartilage of the tip.
  • Shape, mirror and position the domes of the 1° Alar cartilages at the same height .
  • 2° Bring together and join the domes with an interdomal point . A 90 degree angle must be left between the domes.
  • 3° Position and suture the apposition cartilage graft in case of an insufficiently sized dome .

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