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Smart Rhinoplasty... Trademarked and Ready to Market by Paul S <a href="http://www.2014soccercleats.com">Buy 2014 soccer cleats Online</a. Nassif, MD One of the concepts I want to talk about is a Smart Rhinoplasty. When you perform a rhinoplasty, you have to make sure that you don?t cause problems with the nose, especially in the future. Any time you make the nose smaller, you are essentially narrowing the airway. In general, a reductive rhinoplasty will cause some type of nasal destruction, whether it is immediately post-op or five years down the line. So in essence, if I am going to make a nose smaller, I want to make the nose functionally stronger. The reason why I say this is because I?ve seen many rhinoplasty procedures, including my own, that have had basic procedures such as a hump reduction, osteotomies to narrow the nasal bones and basic tip refinement. When I mention the word tip refinement, I mean a cephalic trim which means removing a small part of the nasal tip cartilage, while leaving 7 mm of cartilage using sutures to narrow the nasal tip. You would think that this conservative treatment of the nose would not cause any problems, but it does in many scenarios. In these basic procedures, whether it is a closed or open rhinoplasty can take anywhere from one and a half hours to two hours. Unfortunately, any time between six months and many years later, many of these patients will come in with some type of nasal deformity or nasal obstruction. While this does not happen with every patient, we have to make sure that the nose is strong so this won?t happen. Some of the examples of nasal deformities that I have seen following rhinoplasties are, starting with the middle vaulted nose, inverted V deformity. This is a collapse of the middle vault of the nose where the upper lateral cartilages attach to the nasal septum and the nasal bones collapse in just below the bones. An upside-down V becomes present and also causes nasal obstruction. This usually happens because the trauma to the nose caused removing a hump and fracturing the nasal bones leads to destabilization of the upper lateral cartilages <a href="http://www.kobeixelite.com">Kobe VI Elite Sale Online</a. What I do to prevent this is place spreader grafts. Spreader grafts are small pieces of cartilage usually obtained from the septum that is placed in between the upper lateral cartilage and the septum following a reduction. This stabilizes the middle vault of the nose. The negative thing about placing spreader grafts is that it does cause a slight increase in width in the middle vault of the nose, however, this will usually correct itself any time from six months on out. The grafts are usually only approximately one to two millimeters in width. However in patients with short nasal bones and a long middle vault, the chance of having an inverted V deformity is quite high. Another problem that occurs with the nose after rhinoplasty is something called external valve collapse. This is where the tip cartilage, aka lower lateral cartilage or alar cartilage, collapses especially on the lateral aspect of the tip. And, one of the main questions I always ask myself is why did this happen with conservative therapy where a little cartilage is removed and tip sutures are used. When this area collapses in, this usually causes nasal obstruction and deep alar creases. Sometimes the alar creases can make the nasal tip look bulbous, when in essence the nasal tip is smaller. However, the collapsed ala makes the tip more noticeable. This happens because the healing of the nose is complicated and three dimensional. Shrink wrappage of the nasal soft tissue begins while the patient is healing. The skin shrinks to the nasal skeleton after surgery. The more surgeries you do, the more of a chance shrink wrappage with asymmetry can occur. The skin can shrink asymmetrically, where one side can shrink more than the other. The shrinking can cause more problems due to one side of the nose having prolonged swelling and the other side healing normally. Some of the other issues that occur from basic tip surgery are from dome sutures. By placing stitches in the nose, called dome sutures, to nail the tip, is an impingement of the lateral part of the alar cartilage into the nose. In essence, the dome binding suture makes the part of the alar cartilage collapse in on the nose which causes nasal obstruction. Another deformity that occurs with aggressive tip work is overzealous tip rotation, where the tip is pushed up. This can cause a very short nose and alar retraction, where the nostrils are pulled up and you can see inside the nose quite well. This is why it is very important to be absolutely conservative with the nose, even though patients demand a significant change immediately. To help prevent collapse of the alar cartilage, I will use lateral crural strut grafts. These are pieces of cartilage either from the septum or the ear that I place on the posterior, or underneath, the surface of the alar cartilage. This cartilage is usually 5 mm in width and usually extends along the length and even past the length of the preexisting cartilage. A small pocket is made underneath the preexisting cartilage, and the support graft is placed underneath to prevent the cartilage from collapsing in the future. This will cause a slight bit of fullness in the lateral aspect of the nose, possibly even up to a year. Once again, I am taught to look at long term solutions so these patients will have the absence of nasal obstruction and a collapsed tip. The other structural grafting that I will place in the nose is a columellar strut. This is a piece of cartilage that is put in between the nasal tip which stabilizes the nose and makes it prevent collapsing. This also helps maintain projection. The other issue that comes into play is aggressive tip surgery in patients with thick skin. This can be ethnic patients or patients with thick skin or from previous scar tissue build up. The more cartilage removed from the tip, the more support the tip loses and the higher risk you are at having an asymmetric and amorphous nose. The patient feels that if you remove more of the tip cartilage, you will have a more defined nose. This is far from the truth since the thick skin is what is preventing the nose from being defined. Take the example of a round circular tent, and then placing a pole in the middle of the tent and elevating it. As you elevate the tent into more of a sharper or triangular tent, the top of the tent will appear more narrow then the rest of the tent. Therefore, we take this concept into the nasal tip by adding projection. Crushed or diced cartilage in the infratip lobule can increase the projection and cause the nose to look smaller and refined. So when we take into account a reductive rhinoplasty where the nasal hump has been removed, osteotomies are preformed and nasal tip work, now we are looking at approximately two hours. This also included opening up the nose since most of these procedures are done with an open rhinoplasty. After the reductive rhinoplasty is performed, then we have to start rebuilding the nose with the columellar strut, spreader grafts and lateral strut grafts. This is the reconstruction aspect of the nose which can take approximately another hour. Following the reconstruction aspect of the nose, now we have to make sure the nose looks fantastic. I?ll start at the nasal dorsum and continue along the nasal tip to make sure every aspect of the nose is as perfect as I can make it. I?ll make sure the profile is smooth and the tip is symmetric. The naked eye is a good way to look for any of these irregularities; however, if you look at the nose through the camera, you will see more of the irregularities. If you notice any time when you take photos of the nose, you will see more irregularities with the photos then you would with the naked eye. One of the other areas that I will really pay attention to is the supratip break, which is the area if you look at the profile, just before the tip starts to elevate. You want to make sure you have a nice smooth supratip break especially in females. For the male patients, you want to have a straight nasal line. The infra-tip lobule is an extremely critical aspect of the nose, which pre vents the nose from shortening following rhinoplasty. In many cases I?ll place loose cartilage in the infra-tip following the rhinoplasty. The finessing part of the procedure could take an extra 30 minutes. Now if we take a look at the time, we are approximately 3.5 to 4 hours. You cannot rush a rhinoplasty if you are looking for long term results. If the concern is immediate short term, then the rhinoplasty can be performed in a rapid manner and you will look good temporarily. But once again, I am not looking at the short term, I?m looking at the long term. When I mean long term, I?m talking anywhere from between one and ten years. It is my pleasure to have patients come in that have a symmetric nose years after surgery and also can breathe through it. In addition, sometimes I?ll have to strengthen the nostrils. The nostrils can collapse and therefore we might have to reposition the tip cartilage or add rim grafts. Rim grafts are pieces of cartilage along the rim, so that the nostrils won <a href="http://www.2013freeshoe.com">2013 Nike Free Running Shoes</a>?t retract up. Or we will have to reposition the tip cartilage from a position where the tip cartilage is aiming up to the i nner aspect of the eye to a more of a natural position aiming at the inferior aspect. In essence, any time you do a rhinoplasty, you have to make sure that the airway is also clear inside the nose. We want to examine the septum to make sure it is not deviated, and we want to look at the turbinates to make sure they are not thick. If the septum is deviated or if we need cartilage for grafting, such as placing the grafts as I mentioned before, we are going to perform a septoplasty. This will also help correct and open the nasal airway if there are any irregularities in the nasal septum. We will apply heat to the inside of the turbinates to help shrink the mucosa and fracture the nasal bone to make sure the airway is open. I don?t recommend removing the turbinates, because that can result in a chronic dry nose and the feeling that too much air is going into the nose. If you have too much air going in your nose, there is no nasal resistance. However, it will feel that you have a nasal obstruction, even though the airway is absolutely open. So, in essence, whether it is the Breathe Right rhinoplasty or my term, the Smart Rhinoplasty, you just want to make sure exactly what the doctor is going to do. You want to make sure that there is not too much over-resection of any of the cartilage in the nose, since it may look fantastic for the first six months, even a year, but then you have to worry about the long term results. Our goal is to make the nose as perfect as possible; however, it will be swollen possibly for up to a good year. A skilled facial plastic and reconstructive surgeon with a distinguished background, Dr. Paul S. Nassif has received international recognition for his innovative surgical techniques in revision and ethnic rhinoplasty. <a href="http://www.2014michaelkorsoutlet.com">Cheap 2014 michael kors Outlet Store</a
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