Nose Plastic Surgery

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The nose, the most prominent feature of the face, is subject to developmental and acquired deformities. Most of the surgery of the external nose is done for cosmetic reasons because the individual is unhappy and conscious of a hump or other deviation from the normal. Patients of this type are mentally disturbed, focusing their attention on the deformity, and not until surgical correction has been carried out are they relieved. In a woman, the result is often a gratifying change in mental outlook, but in a man there are oftentimes deep-seated problems that are not solved by the nasal operation. In most rhinoplastic or nasal surgery the goal is a straight, narrow nose with a delicate tip, slightly angulated upward and forming a slender triangle with the lip when viewed from below. To ensure that the appearance of the reshaped nose blends with the general features, however, the surgeon studies the face as a whole before undertaking any nasal surgery.

The more real deformities of the nose are those resulting from a fracture that has been overlooked and left uncorrected, or from a minor injury to a child, whose nose then develops abnormally with the growth of the face during the teens. In the former case, the injury may have been overlooked because of the swelling associated with it or because of failure to appreciate minor displacements that may be obvious only as the swelling decreases. .In the latter case, the injury may stimulate the development of such external deformities as twisting or flatness of the nose as well as internal deviations of the wall separating the nasal passages (septum).

Certain infections of the nose cause loss of the septal support and a saddle deformity. If this occurs in childhood, the whole central portion of the face may be underdeveloped. This deformity may also be caused by injudicious septal surgery or by severe injuries.

Total loss of the nose may occur from extensive cancer surgery, from severe war wounds of the face, or as a punishment for a misdemeanor (an ancient custom revived during World War II by the Nazis). Some of the earliest recorded plastic surgery was undertaken to correct such deformities. The use of skin from the forehead to reconstruct the nose is known as the Indian method, since it originated in the hands of itinerant craftsmen in ancient India. When skin from the arm is used for this purpose, the process is known as the Italian method, because it was described in the 16th century by an Italian surgeon, Gasparo Tagliacozzi (1546-1599).

Almost all rhinoplastic surgery, including that for congenital deformities due to cleft lip, is done through incisions within the nose. The excess bone and cartilage are cut down and removed, and the width of the nose and any deviations to the side are corrected by refractur-ing the bony attachments of the nose and splinting the bones in a normal position until union has taken place. A depression is corrected by reestablishing support with either bone or cartilage transplantation.

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