Tuesday, June 28, 2016

Rib cartilage for revision rhinoplasty

Rib cartilage for revision rhinoplasty is a frequently used alternative if septal cartilage is not available and significant amounts of grafts are necessary for the revision. Rib cartilage is especially helpful when there is a saddle nose deformity after rhinoplasty.

There are two option with rib cartilage for revision rhinoplasty. Using your own rib is an excellent option but requires another operating site with 3-4 inch scar under the breast line. The one rare risk associated with utilizing your own cartilage is a pneumothorax or collapse of the lung. With meticulous surgery and in the hands of an experienced revision rhinoplasty surgeon who uses autologous rib cartilage this risk is quite low.

The other option is cadaveric irradiated rib cartilage. This cartilage is taken from screened donors, purified, sterilized, and then irradiated to assure it is acellular and can be used for grafting. With this option, there is no second site surgery and therefore none of the risks associated with it. The rate of infection and warping have been reported to be the same as autologous rib cartilage. One study has reported that the rate of resorption with cadaveric rib cartilage is slightly higher than autologous cartilage with revision rhinoplasty.

Irradiated cadaveric rib cartilage is safe and a viable option in revision rhinoplasty. However, some patients prefer using their own rib cartilage for the procedure.

Dr. Funk is a revision rhinoplasty surgeon in Houston.

Sunday, June 26, 2016

Thick Skin Rhinoplasty

Performing rhinoplasty on a nose with thick skin can be challenging. Patients frequently desire a smaller more refined nose but as a surgeon, you are limited by the thickness of their skin. Now, the skin can be thinned a little from the underside by removing a fat/fascial layer, but the skin itself cannot be made much thinner during rhinoplasty without damaging the blood supply to the skin and leading to scarring.

The analogy I give rhinoplasty patients with thick skin is that the cartilage and bone of the nose is like a block of marble and we are going to carve a fine statue of it. At the unveiling, we can wrap a thin sheet tightly around the statue and we will be able to still delineate some of the fine details of that statue. However, with thick skin, this is more like wrapping it with a thick blanket or a comforter.

The nose can be made smaller for patient with thick skin during rhinoplasty, however, patients’ expectations need to be discussed as the nose cannot be made as small as someone with thin skin.

Dr. Funk is a top rhinoplasty surgeon in Houston.

Monday, June 13, 2016

Fixing a broken nose

A nasal fracture due to trauma should be evaluated sooner rather than later. Fixing a broken nose can be done relatively easily as long as the fracture is addressed within the first two weeks before the bones have set. There are two indications for fixing a broken nose or performing a closed reduction of a nasal fracture. Once the swelling has subsided, the nose is evaluated for a deviation. If you feel your nose is significantly deviated or crooked since the trauma, a closed reduction is an option. If you feel your nasal breathing has been compromised since the trauma, this procedure may also help.

A closed reduction of a nasal fracture is typically performed under anesthesia for patient comfort. Using instruments and digital manipulation, the bones are reset into a straight position.

If the bones have already set after a fracture, another option is to wait and perform a more formal rhinoplasty to striaghten the nose by using controlled fractures.

Dr. Funk is rated a top rhinoplasty surgeon in Houston.

Monday, June 6, 2016

Is rhinoplasty permanent?

Many patients ask, does the nose grow as you age? The nose does not grow as we age, but it does lose ligamentous support just like many of the aspects of our face. Therefore, the tip may descend leading to the appearance of a longer nose with a small hump.

Rhinoplasty or nose job surgery, performed correctly, will provide you with a nose for life. After things have healed from the procedure, a fine layer of scar tissue will form between the skin and the cartilage and bone. This scar tissue will keep the nose from descending or succumbing to the effects of aging and gravity. As long as the nose has been supported, specifically, the nasal tip, with a columellar strut or tip supporting sutures, the nose will maintain its position. Therefore, rhinoplasty is somewhat a permanent fix for the effects of the aging nose.

Dr. Funk is rhinoplasty surgeon in Houston, TX.

Wednesday, June 1, 2016

How is Rhinoplasty Performed?

Many patients ask how is rhinoplasty performed? This depends on the surgeon’s experience and training and is variable from one surgeon to the next.

Open rhinoplasty or an external approach requires a small skin incision between the nostrils while the rest of the incisions are inside the nostrils. Closed rhinoplasty or endonasal rhinoplasty incisions are all inside the nostrils. With the open rhinoplasty approach, the nasal skin is elevated off of the cartilage and bone and this framework is then reshaped, sutures, or grafts are added. With the closed or endonasal approach, visualization is more limited and it is more to difficult to precisely place grafts and sutures.

Is skin removed during rhinoplasty? Typically, unlike facelift or eyelid surgery, no skin is removed during rhinoplasty. The bony cartilaginous framework is reshaped and the skin needs to contract over it. This is why swelling lasts a little longer with rhinoplasty.

There are over 200-250 different types of maneuvers, grafts, suture techniques and cartilage repositioning procedures in rhinoplasty which is why it is such a difficult procedure.

Dr. Funk is a top rhinoplasty surgeon in Houston, TX.