Rhinoplasty - Female - Plastic Surgery - Dr. Juris Bunkis
Speaker 1: This 29-year-old female, who is relatively thin and attractive, has a nose which is a little large for her face. That same nose would have looked fine on her brother, but on her, it doesn't look as well, doesn't match her features. If you look from the front, you'll see that it's a little thick. It's a little convex at the tip. We're going to thin the tip.
If you look at her on the side, you'll see how this is retruded. We're going to place a little graft down here and we're going to remove a little piece from here. We're going to take some of the top off. In a perfect nose, the tip is higher than any other place on the dorsum. On her, you can see that this is the high point of the nose. So we're going to bring this down a few millimeters, make this a high spot, rotate this up so that the angle between her lip and her nose is more like 90 degrees, and we'll give her more feminine nose that matches her face.
I will show you an example of a very similar lady who had the same operation because I have her before as an after. Obviously, this gal, we're not going to get them for a few months. This lady was a little younger. She was about 19, but if you look at her, she's got a relatively thin nose but a bump right here. You'll see that better from the side view. As you come down to the tip, she's got a convexity. She's got a little bit too much cartilage in here. A more attractive nose has a slight concavity in here. You can't see the base of her nose because her nose hooks down a little bit.
What we're going to do for this or what we did for this lady is take down the top of her nose, thin her tip, rotate her tip up, and give her more feminine looking nose. This is what she looked like before and after. This is what our patient from today can expect something that looks like this. Here, you can see that this is the high point of her nose and it slopes down to the tip. In this one, this is lower and it goes up to the tip. She's got a nicer angle between the lip and the nose. If you look from the front view, the tip is slightly concave instead of looking like a box and bulging out. This is how we do noses at Orange County Plastic Surgery.
Okay. This is a 29-year-old female who's having a rhinoplasty today. You can see main concerns are the little hump that she has. When you look at the profile of a nose, you want this to be the high point of the nose, not somewhere up here. The other thing she has, her tip looks a little bit like a beak. It hangs down. You can see this part is retruded. What we're going to do here, shorten this just a little bit and add a little graft down over the nasal spine.
First thing we're going to do is inject some local anesthesia, and that is injected to enhance constriction of the blood vessels and lets us work without too much bleeding. You can see that she's got a convexity here. It's a little more feminine to have a slight concavity here. We're going to achieve that by making incisions roughly here just below the alar rim on the inside, going through the pink stuff, exposing this cartilage, taking out the upper part, and then you'll see a more refined tip.
This is how we do it. First, we make a little incision inside here. The incision goes right here. Then we take some scissors and we dissect the pink layer off the cartilage. We hold it with some little skin hooks. Okay. Here, we've exposed the lower lateral cartilage. We leave a rim, a couple millimeters at the top that we're going to leave intact. We make an incision across that cartilage. We're going to take out the upper part of it that we don't want. Now, we're going to dissect between the cartilage and the nose skin. That'll free it up totally. It will allow me to take it out.
Can you [inaudible] this side, please, and hold this? This is the piece of cartilage we took out. You will see ... [inaudible] doing that? You can see, once they took that cartilage out, this is slightly concave and this is still convex. That, by the way, is the zit that she had. That's nothing to do with our surgery, but you can see how this softened this and made it flatter than this little bulge.
Now, we've refined the tip on both sides. It's nice and thin. This is still retruded and she still has the bump. Next thing we're going to do is dissect the top of the nose and take down the bump. We do that with a rasp. We insert it in the little tunnel we made and we just go back and forth. This is analogous to a little rasp you use for your fingernails to bring down a little irregular in your nail. Just works very, very well on bone. It does not take down the cartilage. The cartilage, we have to shave with a scalpel. You can see the dorsum coming down. I'll show you the side view in a few minutes.
Here, you can see that we've refined the tip and we brought down the dorsum. Now, this is the high point of the nose. Last thing we're going to do is we're going to infracture it, we're going to cut the bones right here and along the sides of the septum to free this up so we can narrow the nose. If you look at her now, this is nice and straight with this being the highest point. This is thin. Everything looks good except this top is very flat and looks like an aircraft carrier because we took down the bump. What we do now is we cut the bones here, cut them here, and push them back together again to reestablish another pyramid.
Okay. You noticed the sound changed? That's when I know we've gone far enough. Okay. Now, when we do these lateral osteotomies, it's common to get a little bit of bleeding. We're going to poke this little tool through, seat it on the bone, and away we go. Done deal.
You can see the dorsum is down, thinned tip. This is up a little bit, doesn't look like a beak anymore. In order to keep it there, we're going to put on some tape and a splint. That will stay on for six days. When we see her next, she might have a little it of bruising around her eyes, but I doubt it. If you look at her, she doesn't have a bruise on her. This kind of helps support the tip. The rest of the tape goes on like this. We get a good preview of what her nose is going to look like after the swelling goes down. Next, we grab the splint and this is in hot water. It's very malleable as you can see. We put that on, form it the way we want it. We're not there yet. We give it a squeeze, nice and symmetrical, and we pour on some cold water to help it set. Thank you.