To the layman, aesthetic nose correction has a magical aura about it.
The operation involves “invisible scars” that are situated on the inside of the nose, and certain parts of the surgical procedure, such as removing the bony hump or mobilizing the nasal bones, is done “by feel” and relies very much on the surgeon’s experience.
The difficulty of learning the technique of closed rhinoplasty led to the development of open rhinoplasty, where the skin covering the lower part of the nose is detached through an incision in the skin of the nasal base.
This leaves a visible scar of no more than 5mm.
History
Documentary evidence of nose restoration following loss by amputation has been found from around 3000 BC in ancient Egypt, around 800 BC in India, and from 16th-century Italy.
A report of a modern closed rhinoplasty was published for the first time in 1887 by Dr Roe, an otorhinolaryngologist in the USA. The founder of the modern technique was Dr Jacques Joseph, a German orthopedic surgeon who presented his method in 1898. The use of incisions inside the nose is what made this technique so revolutionary.
Other famous surgeons from the early days were Gustav Aufricht, Samuel Fomon and Maurice Cottle, all from the USA and still known for the rhinoplastic instruments named after them, and which are still being used today.
Technique
INCISIONS AND DISSECTION
The skin is detached from the underlying nasal skeleton through incisions in the inside top of the nostril and on the side of the partition. The mucosa is detached from the side of the partition and from the roof of the nasal bridge.
In open rhinoplasty, the incisions on the side of the partition are linked to each other by a transverse incision of the skin. In this way, the skin can be detached from the nasal tip and from the lower half of the nasal bridge as well.
ALTERING THE NASAL STRUCTURE
Nasal tip: this procedure usually involves altering the shape of the nasal tip by removing fragments of cartilage and changing the shape of the remaining cartilage by applying sutures that make the new shape permanent.
Nasal bridge and partition: after the mucosa and the skin have been detached from the bone and cartilage of the nasal bridge, the shape of the nasal bridge can be made more harmonious by removing the nasal hump.
This opening is sealed by loosening the nasal bones near the transition to the skull bone by breaking them with a fine chisel and moving them closer to each other.
The opening in the cartilage of the lower half of the nasal bridge is sealed by reattaching the edges of the cartilage to each other.
CLOSING AND IMMOBILIZING THE NASAL STRUCTURE
The incisions on the inside of the nostril, the partition and the skin are closed with fine absorbable sutures.
In order to prevent the loosened nasal bones from moving apart, they are immobilized with a nose plaster or thermoplastic splint.
