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Rhinoplasty
Rhinoplasty has been around for
centuries. Jacques Joseph was known to have performed
thousands of cosmetic rhinoplasties in early 20th
century Germany. Since that time, techniques have been
improved and so have the results. However, even with a
century of experience, plastic surgeons are still faced
with inconsistencies in the results that yield a 15%
secondary surgery rate.
Why do so many patients return
for corrective surgery? Well, part of it has to do
with patient expectations. Quite often, patients expect
results that mirror their favorite movie star or pop
icon, only to be disappointed when their own unique
anatomy limits a surgeons abilities to achieve those
desired results.
Another reason for revision surgery
has to do with scarring. Internal scarring can cause
deformities that change the shape of a nose. A small
(1-2 millimeter) deformity of the nose is readily
apparent, while a similar asymmetry in any other part of
your body is easily camouflaged.
Finally, inconsistent results may
be due to unrecognized internal anatomy that was not
adequately treated with routine rhinoplasty techniques.
It is for each of these reasons that nasal surgery (more
than any other surgery) should be performed by
physicians that specialize in these types of procedures,
and are well versed in the more complicated maneuvers
necessary to treat more difficult noses.
The routine rhinoplasty is known as
a closed technique. All maneuvers to alter the shape and
function of the nose are performed through two small
incisions inside the nostrils. This technique is
excellent for routine removal of bumps on the nose, but
falls short in more complex repairs that involve
correction of the nasal tip or twisting deformities. The
benefits of this technique include easy recovery,
minimal swelling and invisible scarring.
Procedures designed to correct
nasal tip irregularities, twisting deformities or
secondary procedures are more readily accomplished
through an open tip or tip delivery
method. The Open Tip procedure requires a small
incision on the skin at the base of the nose in between
the two nostrils. The incision heals nicely and is very
hard to see, but the patient also has prolonged swelling
in comparison to the closed technique.
If there are drawbacks to this
technique, why is it so popular among surgeons who
perform secondary rhinoplasties? Well, this
technique allows for ultimate control and precision
correcting deformities of the tip and middle third of
the nose. It is also an excellent way to correct
difficulties in airway function (known as internal
nasal valving) that can be the result of previous
rhinoplasties.
The Tip Delivery method
eliminates the incision at the base of the nose, and
minimizes the swelling but is somewhere between the open
and closed tip techniques in its’ surgical control and
precision.
Dr. Freund is well-known as a
secondary rhinoplasty surgeon.He feels that his
experience with these more difficult procedures, makes
him better qualified to perform a primary rhinoplasty.
With regard to the specific technique, Dr. Freund uses
all three techniques and tailors them to the person and
their specific problem.
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