Small Nose

People considering rhinoplasty usually look for a smaller or more refined nose. Sometimes, the existing nose is actually too small and should be made larger in order to better fit the patients face. Most commonly, this is the case in revision rhinoplasty, when the initial quest of a smaller nose lead to a nose that is now too small. Sometimes, nasal trauma or diseases of the nose can lead to a depressed or caved-in nose (i.e. saddle nose deformity). Rhinoplasty in patients of Asian or African-American background may involve aspects of augmentation. In general, modern rhinoplasty focuses on maintaining the structural integrity of the nose. Therefore, whenever grafts are placed in the nose for structural gain or to make it a little bigger, the longevity of the result is improved.

Raising the Nasal Bridge

Augmentation rhinoplasty commonly involves the nasal bridge (nasal dorsum) when it is too low. The dorsum can be raised by introducing implants or grafts. Implants are man-made (i.e. Silastic, Goretex, Medpore etc.); grafts originate from the patient’s own body (cartilage, bone). Deciding on the right material depends on the exact deformity, aesthetic goals and the availability of grafts in the patient. In addition, the surgeon’s experience and preference plays a crucial role. Options for autologous (i.e. patient’s own) grafts include nasal septal cartilage, rib cartilage, ear cartilage or skull bone.

Augmenting the Tip Region

The distance between the cheek and nasal tip is also called projection. When a patient lacks tip projection, enhancement usually involves use of grafting materials. Most rhinoplasty surgeons today use cartilage for these purposes although artificial implants are also available. Grafts required depend on the nasal deformity and tip support. Commonly, columellar strut grafts placed between the tip cartilages will provide additional tip support and prevent further collapse. Additional projection can sometimes be achieved. Tip grafts or extended tip grafts are successfully used to achieve improved tip projection and tip shape.

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