Are you a candidate ?

If majority of rhinoplasty candidates are women between 19 and 50, teenagers, elderly and men patients are sometimes operated.

Young patients

Rarely, a nose can be operated in the childhood when the patient presents with severe difficulty in breathing caused by a deviation of the septum, but purely aesthetic surgery of the nose can usually be performed around 15-16, once the patient have completed his growth, and mostly when the deformity has an impact on psychology.Young patients often worry about a deformity of the nose and correction can achieve tremendous improvement in their psychology making them more self confident and more happy.

Obviously, under 18 rhinoplasty need an interview with parents.The surgeon will have to establish the patient’s complex and hopes he places in nose surgery. Indeed, motivation must exclusively come from the patient himself and not from his parents. Since the patient is not an adult, both parents will have to sign a consent.

Rhinoplasty on a 16 years old patient.

Elderly patients

Rhinoplasty is commonly considered as an operation for teenagers and young adults, but we often see in our consultation patients in their midlife and sometimes in their sixties requesting a rhinoplasty, sometimes associated with a breathing improvement or a facial rejuvenation procedures.

Both physical and psychological, these patients present clearly different problems from those of the traditionnal young adult and teenage. Psychologically, midlife patients body image is mostly strongly imprinted in their mind and a change in facial features other than conservative may be highly stressful. Physically, aging changes may affect the nose in many ways : decreased skin elasticity, fragile bones, potentially calcified cartilages... All these modifications must be known and considered by the surgeon.

For all these reasons, conservative and subtle changes in the aesthetic appearance of the nose must be performed on elderly patients. At the same time, such small modifications of the nose will often have a rejuvenation action.

Rhinoplasty on a 67 years old patient (No other rejuvenation procedure)

Breathing problems - Deviated nose

Breathing problems can be and should be corrected in the same stage.

One has first to determine the cause of the problem : it can be a curvature of the septum, a hypertrophy of the turbinates or a weakness of the cartilages. In each case, an appropriate treatment should be performed as well as corrections of deformities of the external nose. A specialist of the nose surgery should be able to do both.

The nasal septum is composed of a posterior bony portion and an anterior cartilage portion. Usually, a posterior deviation can be responsible of difficulty in breathing but doesn’t modify the shape of the nose. On the opposite, deformities of the anterior portion of the septum can also decrease breathing and are frequently the cause of visible deformities on frontal view and deformities of the nostril orifices. Various kind of deformities must absolutely be known by the surgeon who will sometimes need a scanner.

Rhinoplasty on a widely deviated nose with breathing problem.

Ethnic Rhinoplasty

Some asian and afro-american people may present with low dorsum, underprojecting and bulbous tip, wide alar base and acute columella labial angle (looking down tip). Mostly, their wish is to reduce the nostril’s flaring, increase the dorsum projection and refine the tip shape.

Cartilage grafts are used in order to augment the dorsum, improve the support of the tip and its contour. A large amount of cartilage is necessary for these corrections. It will be harvested in the septum, behind the ear and, sometimes, on the rib cartilage with a short 2-3 cm incision under the breast.

At the completion of the surgery, alar base resection is performed with an incision placed in the crease between the cheek and the ala.

Ethnic nose patients must understand that skin thickness, mostly on the tip, can sometimes limit the possibility of refinement of the tip. Anyway, to be natural and harmonious, even if they are increased, a nose must keep its ethnics features.

Ethnic rhinoplasty with augmentation of the dorsum, projection anf refinement of the tip (use of cartilage grafts)

Congenital deformities

Congenital deformities present whith complex and asymmetric deformities of the cartilage framework. Their correction need a wide experience of this type of surgery and will sometimes be very close to reconstructive surgery.

Cleft lip nose

Generally, the child already underwent several surgeries during the early monthes of his life but other rhinoplasty surgeries are often necessary around the adolescence in order to improve cosmetic and function of the nose. Restoring a strong support in the lower part of the nose and putting the philtrum and nostrils in a balance and anatomic position will be the main goal of these rhinoplasties.

Rhinoplasty on a cleft lip nose who already underwent several surgeries in the childhood

Maxillary Hypoplasy

They correspond to a failling growth of maxillary bone and can be included in syndromes such as Binder’s syndrome. The midface is generally flat, the dorsum of the nose is decreased and the philtrum is too high. Correction will need several cartilage or bone grafts and will sometimes require an incision inside the mouth.

Rhinoplasty on a Binder’s syndrom. Use of carilage grafts.

Reconstructive rhinoplasty

Reconstruction of the face, and escecially the nose, tend to bring back a normal appearance to a partially or totally amutated nose. Causes of such amputations can be skin cancers, traumatism, burn, cocaine but, whatever mechanism is in cause, this will be a real tragedy for the patient and his entourage.

Nasal and facial reconstruction methods are numerous, from simple to more complicated, but will always use cartilage or bone graft. The missing skin will be replaced by the remnant skin of the nose, the skin of the nasolabial fold, of the forehead or, in very large defects, of the forearm.

Only specialist of face reconstruction surgeons can pretend to obtain good result. A specific chapter is consecrated to nasal reconstruction.

Patient who underwent an amputattion of the tip for a carcinoma. Nasal reconstruction with a three stages forehead flap and ear cartilage graft.

Where are the scars after a rhinoplasty ?

After a rhinoplasty, there will always be scars inside the nostril. Furthermore, often, there will be a scar under the columella (thin part of the nose situated between the two nostrils).

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