Rhinoplasty in patients with a wide nose
When a patient comes to be operated on rhinoplasty, planning is very important. In particular, I always perform a careful exploration of the entire nose, in the case at hand, which are patients with a wide nasal tip, I carefully examine the tip, both visually and manually, to obtain a detailed understanding of the soft tissue envelope of the skin and alar cartilages complemented by intranasal endoscopic examination.
Rhinoplasty in patients with a wide nose and the preoperative period
The preoperative examination of the nasal tip is intended to give us a better understanding of the underlying anatomy.
Another very important factor is to carry out correct photographic documentation. The nasal tip depends on the shape and configuration of the alar cartilages, which are 2 and each have three parts: the medial cross, the intermediate crus and the lateral crus. The most common form of the wing cartilages closely resembles gull wings.
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Rhinoplasty in patients with a wide nose and its causes
Although there are numerous causes for which a patient may have a broad nose in general, because the alar cartilages are strong and wide, especially at the level of the lateral crus.
Another possible cause is an excessive divergence at the level of the Intermediate crus that configures an appearance of a wide and square point, this is due to the fact that there is a greater angle of divergence than usual at the level of the intermediate crus.
Types of patients with a wide nose
In some patients a weak cartilage structure with thickened nasal tip skin creates a broad nasal tip with poor definition. This is common in patients of Asian or African descent and can be very difficult to correct.
In other patients, however, it may also be due to a combination of thick skin and strong cartilage producing a broad nasal tip.
There are different techniques to correct the wide nasal tip, all of them involve reducing the width of the lateral crus of the alar cartilages. When we do this maneuver we must try to maintain a minimum width of 8 mm in order to avoid a collapse of the airway.
When we perform this resection of the lateral crus, a slight rotation of the nasal tip is produced, which is aesthetically desirable in most cases, but if it is excessive, it can produce an over-rotated nasal tip that gives the impression of an operated nose.
In the vast majority of patients with a wide nasal tip, we can achieve a great improvement with a correct resection of the lateral crus in order to achieve a natural repositioning of the same and a more natural and symmetrical nasal tip.
In patients with thick skin, it can be difficult to achieve an improvement visually because despite the fact that we have corrected the underlying anatomy by correcting the lateral crus, this type of skin is not very elastic, so it adapts little to the changes that we have made. performed by resection of the alar cartilages and in this case it is when it is more probable that we need suture to achieve the desired aesthetic improvement.
If the resection of the lateral crus does not achieve a harmonious aesthetic result, sutures can be made to bring the lateral crus closer to the midline. The sutures can be nonabsorbable, that is, they remain, or absorbable, which disappear after a few months.
The usefulness of the nasal sutures is to keep the alar cartilages in the position that we want, but after about 6 months this has already been achieved since the cartilages are covered by scar tissue that keeps them in this position.
So that after approximately 6 months, sutures can only cause us problems such as intolerances or superinfections, so in Barcelona rhinoplasty, if I need to need sutures, I always use absorbable sutures.
The nasal tip is the key to the success of any rhinoplasty intervention and the correction of the nasal tip represents perhaps one of the most important challenges when we perform a rhinoplasty.
The natural repositioning of the cartilages is difficult because we must consider that the three parts of the alar cartilages interact with each other, that is, when we modify the lateral crus we also affect to a greater or lesser extent the position of the medial crus and the intermediate crus.
A surgeon who is able to correct a wide nasal tip and give it a natural “look” means that he has mastered rhinoplasty. The “piezotome” used to perform ultrasonic rhinoplasty is not useful for solving cartilage problems, so it cannot be used to correct any dysmorphia of the nasal tip and therefore we cannot use it in the case of a wide nasal tip either. .
Finally, remember that the margin we have between success and failure when we perform any resection or suture maneuver on the nasal tip is very low, that is, any minimally incorrect resection or stitches that do not have adequate tension or are not placed in the right position. the correct position can cause a wing collapse and therefore the airway with an excessively rotated nasal tip or an asymmetry of the nasal tip.
The surgeon who masters nasal tip surgery and achieves harmonious and natural nasal tips masters the rhinoplasty technique because it is the most difficult part to achieve.
Peter Beaumont is a senior reporter on the Guardian’s Global Development desk. He has reported extensively from conflict zones including Africa, the Balkans and the Middle East and is the author of The Secret Life of War: Journeys Through Modern Conflict. Email: peter@thehearus.com
