Method of surgically implanting a contour nasal implant

A method is disclosed for surgically implanting a contour nasal implant into a nose of a patient to elevate the nasal tip and to augment and to improve the frontal and profile views of the patient's nose. The method comprises the steps of drawing, onto the nose of a patient into which a contour nasal implant is to be surgically implanted, a line connecting the highest points of the superior palpebral sulci such that the line crosses the nasal dorsum at a point representing the nasion and the highest point of implant insertion; placing two pledgets in each nostril in the nose of the patient; performing an open rhinoplasty incision into the skin located between the nostrils of the patient; retracting superiorly the columella skin off of the lower lateral cartilages on each side of the nostril up to the highest point of the natural dome of the nose of the patient; dissecting the skin off of the dorsum of the nose to the line previously drawn across the nasal dorsum; inserting a contour nasal implant having an elongated central member having a dorsal section, a predetermined shaped tip and a keel having a selected width and length which is located under the predetermined shaped tip with the keel thereof extending downward between the lower lateral cartilage until the desired implantation position is obtained; and suturing the rhinoplasty incision in the skin between the nostrils.

BACKGROUND OF THE INVENTION 
1. Field of the Invention 
This invention relates to a contour nasal implant used in the field of 
aesthetic nasal surgery or rhinoplasty for reshaping the nose to improve 
its appearance, and more specifically, relates to a contour nasal implant 
to be utilized in reconstructive surgery in non-caucasian rhinoplasty 
which requires augmentation of the nasal dorsum and elevation of the nasal 
tip. A method for surgically implanting the contour nasal implant is 
disclosed. 
2. Description of the Prior Art 
It is known in the art to perform plastic surgery to improve physical 
function or to overcome certain deficiencies in facial and body features 
such as disfigurement, scarring or the like, resulting from a variety of 
causes. Plastic surgery includes aesthetic surgery, sometimes known as 
cosmetic surgery, which has the specific purpose of reshaping or improving 
facial features or bodily figures. One popular form of plastic surgery is 
generally referred to as aesthetic nasal surgery or rhinoplasty, which can 
be defined as the reshaping of the nose to improve its appearance. It is 
well known in the plastic surgery field that aesthetic nasal surgery, or 
rhinoplasty, can involve a wide variety of surgical operations which may 
or may not include the use of nasal implants as a part thereof. 
Typical examples of rhinoplasty surgery is where the patient has a large 
nose, nasal hump, and a large tip and a nose that hangs slightly where it 
meets the lips. In such situations, it is known in the art to gain access 
to the cartilage and bone within the nose and to cut and/or reshape the 
same to alter the exterior appearance of the nose. 
Typically, a nasal hump is removed using either a sawing instrument, a 
chisel or rasp, leaving the ridge flat and with the bones and cartilage 
spread. Also, the bone structure can be manipulated to form a narrower 
nasal bridge. In certain situations, in order to reduce the size of the 
nasal tip, part of the cartilage and the lower lateral cartilages may be 
removed. 
Also, it is known in the art to improve the angle between the nose and 
upper lip by elevating the nasal tip which is obtained by trimming the 
septum. A nasal implant may be used if required. 
As the field of rhinoplasty has become more advanced, it has developed that 
certain individuals, particularly non-caucasians, require a special type 
of rhinoplasty which involves augmentation of the nasal dorsum and 
elevation of the nasal tip. As a result, it is a patient's desire that the 
final result look "natural", and this may require that the nasal tip be 
modified in accordance with the patient's desires. 
It is known in the art to utilize a nasal implant which is formed of an 
elongated central member, a flared dorsal section and a septum strut. 
However, in performing non-caucasian rhinoplasty, the shape and physical 
characteristics of the known nasal implants do not provide the desired 
augmentation of the nasal dorsum and elevation of the nasal tip desired by 
the patient. 
Thus, it is known in the art that, by utilizing the surgical procedure of 
an aesthetic rhinoplasty, that the overall size of the patient's nose can 
be modified or reduced, the nasal tip can be reshaped, a nasal hump can be 
removed or a poor angle between the nose and the upper lip can be 
improved. It is also known in the art that it is necessary to add tissue 
in order to improve the contour of the nose. 
It is further known in the art that nasal surgery is performed under a 
local anesthetic which numbs the nasal area. However, in certain 
instances, a general anesthetic may be used. Medication is sometimes given 
to the patient before the anesthetic is administered in order to make the 
patient comfortable during the surgery. 
The known surgical procedure for performing nasal surgery includes making 
an incision inside the nostrils. The nasal surgery is then performed 
through the incision, since the incision is sufficient to gain access to 
the lower lateral cartilage, the nasal bone including the nasal dorsum. It 
is also known in the art that the surgeon, by having access to the 
interior of the nose through the rhinoplasty incision, can cut, trim and 
manipulate the lower lateral cartilage or the bone to reshape the nose and 
alter its external appearance and to insert a nasal implant of the type 
known in the art. 
DESCRIPTION OF THE INVENTION 
The contour nasal implant of the present invention provides a unique, novel 
and improved contour nasal implant to be used in rhinoplasty surgery. The 
contour nasal implant of the present invention includes an elongated 
central member having a first end and a second end wherein the second end 
is spaced a predetermined distance from the first end. The first end is 
flared or somewhat concave in shape to define a dorsal support end which 
is adapted to be positioned over the nasal dorsum in the nose of a patient 
to augment the frontal and profile views of the nose. A second end 
includes a tip having a predetermined shaped which is located on the same 
side of the elongated central member as the dorsal support end. The second 
end further includes means for defining a keel having a selected width and 
length. The keel is located on the second end under the predetermined 
shaped tip and the keel is positioned substantially perpendicular to the 
elongated central member and positioned such that the length of the keel 
is generally parallel to the elongated central member. The predetermined 
shaped tip is operative to elevate the nasal tip of the nose of a patient 
into which the contour nasal implant is implanted and cooperates with the 
dorsal shaped end to contour the skin of the nose of the patient to define 
the desired frontal and profile views of the nose. 
In addition, this invention discloses a novel and unique method for 
surgically implanting the contour nasal implant. Specifically, a method is 
disclosed for surgically implanting a contour nasal implant into a nose of 
a patient wherein the nose has lower lateral cartilages, a nasal dorsum 
and a nasal tip wherein the nasal dorsum and nasal tip are to be elevated 
and augmented to improve and reshape the frontal and profile views of the 
patient's nose. The method comprises the steps of drawing, onto the nose 
of a patient into which a contour nasal implant is to be surgically 
implanted, a line connecting the highest points of the superior palpebral 
sulci such that the line crosses the nasal dorsum at a point representing 
the nasion and the highest point of implant insertion; placing two 
pledgets in each nostril in the nose of the patient; performing an open 
rhinoplasty incision into the skin located between the nostrils of the 
patient; retracting superiorly the columella skin off of the lower lateral 
cartilages on each side of the nostril up to the highest point of the 
natural dome of the nose of the patient; dissecting the skin off of the 
dorsum of the nose to the line previously drawn across the nasal dorsum; 
inserting a contour nasal implant having an elongated central member 
having a first and a second end, wherein the first end thereof has a 
dorsal section which is adapted to be positioned over the nasal dorsum in 
the nose of a patient into which the same is to be implanted and wherein 
the second end includes a predetermined shaped tip located on the same 
side of the elongated central member as a dorsal section and further 
includes a keel having a selected width and length which is located under 
the predetermined shaped tip and wherein the keel has a length which is 
generally parallel to the elongated central member such that the first end 
thereof having a dorsal section is positioned between the nasal dorsum and 
the skin while the predetermined shaped tip portion thereof is located on 
the lower lateral cartilages and the keel thereof extends downward between 
the lower lateral cartilage until the desired implantation position is 
obtained; and suturing the rhinoplasty incision in the skin between the 
nostrils to implant the contour nasal implant within the nose of the 
patient to augment the frontal and profile views of the patient and to 
elevate the nasal tip of the nose of a patient. 
As described hereinbefore in connection with the description of the prior 
art, aesthetic nasal surgery or rhinoplasty, is used to reshape the nose 
to improve its appearance. The type of rhinoplasty required depends upon 
the specific desires of the patient, the specific nose and cartilage 
structure of the patient and other factors such as the general 
characteristics of a nose identified with the heredity background of a 
patient. Certain ethnic groups exhibit nasal characteristics which include 
a concave nasal dorsum or an enlarged nasal tip resulting in the nose that 
hangs slightly where it meets the upper lip. In patients having such 
characteristics, the aesthetic rhinoplasty is performed to improve the 
frontal and profile views of the nasal dorsum and to reshape and/or 
elevate the nasal tip thereby improving the angle between the nose and the 
upper lip. In the known surgical procedures, it is typically necessary to 
add tissue in order to improve the contour of the nose. 
Typically, patients can have the rhinoplasty performed using the known 
nasal implants and/or techniques for reshaping the nose. Such nasal 
implant utilized in rhinoplasty surgery utilizes a central member having a 
flared end which is positioned between the nasal dorsum and the skin to 
elevate the skin and utilizes a septum strut to cause elevation of the 
nasal tip. 
Attempts have been made to utilize the known nasal implants in certain 
non-caucasian patients and these attempts have been less than acceptable. 
One reason is that the known nasal implants have certain deficiencies in 
that certain non-caucasian patients require that the nasal tip be 
significantly reshaped while concurrently elevating the nasal tip relative 
to the lip. The known nasal implants utilizing the septum strut do not 
provide sufficient material and/or structure to provide the desired amount 
of reshaping and elevation that is necessary to meet the patient's desires 
nor do the prior art nasal implants provide sufficient additional tissue 
material to significantly elevate and improve frontal and profile views of 
the nose. Also, the nasal implants are not anchored to the lower lateral 
cartilages of the nose with any anchoring means. 
The present invention overcomes the inherent disadvantages associated with 
the prior art nasal implants for several important reasons. 
One advantage of the present invention is that the contour nasal implant 
includes an elongated central body having a flared or concave end at one 
end thereof which defines a dorsal section and, which has at the other end 
thereof a predetermined shaped tip on one side of the elongated member 
which is spaced from the dorsal section and on the same side of the 
elongated central body as the curvature of the dorsum section, and an 
anchoring means which is preferably in the shape of a keel which is 
located on the elongated body under the predetermined shaped tip thereby 
providing sufficient additional material to provide the desired shaping, 
contouring and elevation of the nose and nasal tip. 
Another advantage of the present invention is that the surgeon, during 
surgery, can trim the dorsal section, predetermined shaped tip or keel, as 
specifically required for the specific implantation being conducted by the 
surgeon, thereby providing individual contouring and profiling the nose 
meeting the desires of the patient. 
Another advantage of the present invention is that the contour nasal 
implant can further include a septum strut so that the contour nasal 
implant can be used for both caucasian and non-caucasian implantation, 
depending upon the patient's desires, needs and physical structure of the 
nose. 
Another advantage of the present invention is that the contour nasal 
implant can have a predetermined shaped tip that is square shaped, 
generally rounded or partially rounded or contoured in the form of a 
truncated pyramid to provide the surgeon with a wide range of 
predetermined shaped tip sizes to perform the desired the reshaping and 
elevation of the nasal tip of the nose of a patient into which the contour 
nasal implant is implanted. 
Another advantage of the present invention is that the keel can be 
positioned to have its outside edge either flushed with or spaced from the 
outside edge of the central body member relative to the predetermined 
shaped tip. 
Another advantage of the present invention is that the dorsal support end 
or dorsal section, which is formed into an arcuate shaped contoured end 
can have a variety of thicknesses in the contoured section to provide the 
surgeon with a selection of various thicknesses to control the amount of 
elevation of the nose relative to the nasal dorsum. 
Another advantage of the present invention is that the implant can be 
formed of a non-biodegradable elastomeric material. In the preferred 
embodiment a non-biodegradable elastomeric material is selected to be 
silicone elastomer. 
Another advantage of the present invention is that the contour nasal 
implant can be utilized in a novel and unique method for surgically 
implanting the same into the nose of a patient. The method for surgically 
implanting the contour nasal implant into the nose of the patient is 
adapted to elevate and augment the frontal and profile views of the 
patient's nose while permitting the surgeon to trim and otherwise prepare 
the contour nasal implant during the surgical process to meet the specific 
needs of the patient into which the same is to be implanted. The surgeon 
can trim any one of the dorsal sections, the predetermined shaped tip and 
the keel of the contour nose implant to obtain the design contour and 
profile for the patient into which the same is implanted. 
Another advantage of the method of the present invention is that the 
surgeon can make a determination as to the amount of elevation required of 
the nose in determining the best procedure to utilize in elevating the 
skin relative to the nasal dorsum. If the nasal skin of the patient into 
which the contour nasal implant is to be implanted is thick over the nasal 
dorsum, the surgeon can elevate the nasal skin alone from the nasal dorsum 
to receive the contour nasal implant. On the other hand, if the nasal skin 
of the patient into which the contour nasal implant is to be implanted is 
thin over the nasal dorsum, the surgeon can elevate some of the soft 
tissue from the nasal dorsum along with the skin to provide the additional 
padding required between the dorsal section of the contour nasal implant 
and the skin. 
Another advantage of the present invention is that the surgeon can utilize 
biodegradable suture material, such as catgut which contains collagen or a 
suture material containing collagen, to suture the rhinoplasty incision to 
provide the minimum scarring disfigurement in the vicinity of the incision 
and to result in reducing, to the extent reasonably possible, the 
appearance of the rhinoplasty incision in the nose. 
Another advantage of the present invention is that the surgeon has the 
ability to utilize a non-biodegradable suturing material for suturing the 
skin to the nasal dorsum. When the nose has sufficiently healed, the 
non-biodegradable suturing material can be removed from the patient's nose 
.

DESCRIPTION OF THE PREFERRED EMBODIMENT 
FIGS. 1 through 7 disclose the preferred embodiment of a contour nasal 
implant which is shown generally as 30. In FIGS. 1 through 7 the contour 
nasal implant 30 includes an elongated central member 32 having a first 
end shown generally as 36 and a second end shown generally as 40. The 
second end 40 is spaced a predetermined distance from the first end 36. As 
illustrated in FIGS. 1, 2 and 7, the first end 36 is flared or defines a 
generally concave surface comprising the dorsal support end or dorsal 
section 44. The dorsal support end or dorsal section 44 is formed into an 
arcuate shaped contoured end which is utilized to shape the frontal and 
profile views of the nasal dorsum of a patient into which the same is to 
be implanted. The second end 40, which is located in an opposed spaced 
relationship to the first end 36, includes means defining a tip having a 
predetermined shape, shown generally as 50. The predetermined shaped tip 
50 is located on the same side of the elongated central member as the 
direction of the curvature of the dorsal support end or dorsal section 44. 
The second end 40 further includes anchoring means, such as for example, a 
keel, shown generally as 48, having a selected width and length. The keel 
48 is located on the second end 40 under the predetermined shaped tip 50. 
The keel 48 is positioned substantially perpendicular to the elongated 
central member 32 with the length of the keel generally parallel to the 
elongated central member 32. The predetermined shaped tip 50 is operative 
to elevate the nasal tip of the nose of a patient into which the contour 
nasal implant is implanted as shown generally in FIG. 18. 
The contour nasal implant of FIGS. 1 through 7 has a predetermined shaped 
tip which is generally trapezoidal shaped. However, it is envisioned that 
the predetermined shaped tip could have any number of predetermined 
shapes, such as for example, square shaped, generally rounded, partially 
rounded, or the form of a truncated pyramid. Certain of these are 
illustrated in connection with the discussions of FIGS. 8 through 14 
hereinbelow. 
In the embodiment illustrated in FIGS. 1 through 7, the keel 48 has an 
outside edge 52 and an inside edge 54. Also, the predetermined shaped tip 
50 has an outer edge, shown generally as 56. In the embodiment of FIGS. 1 
through 7, the outside edge 52 of the keel 48 is located away from the 
outer edge 56 of the predetermined shaped tip 50. When the contour nasal 
implant 30 is implanted into the nose of a patient, the keel 48 selected 
to be of an appropriate dimension such that the keel thereof extends 
downward between the lower lateral cartilages of the patient until the 
desired implantation position is obtained. This will be discussed further 
in connection with FIG. 18. 
FIGS. 8 and 9 illustrate another embodiment of a contour nasal implant. The 
contour nasal implant of FIG. 8 has an elongated central member shown 
generally as 70. The predetermined shaped tip, shown as 76, is partially 
rounded compared to the generally rounded predetermined shaped tip 50 of 
FIGS. 1 through 7. Also, the elongated central member has a dorsal support 
end or dorsal section 78 which is substantially thicker in dimension 
relative to the dorsal support end or dorsal section 44 illustrated in 
FIGS. 1 through 7. Also, FIG. 8 illustrates that the predetermined shaped 
tip 76 has an outside edge 82 and that the keel 80 has an outside edge 84. 
In the embodiment illustrated in FIG. 8, the outside edge of the keel 80 
is substantially flush with the outside edge 82 of the predetermined 
shaped tip. 
FIGS. 10 and 11 illustrate another embodiment of a contour nasal implant 
shown generally as 90. The contour nasal implant 90 includes an elongated 
central member 92 having a predetermined shaped tip 96 located at one end 
thereof and a dorsal support end or dorsal section 98 located at the other 
end thereof. The predetermined shaped tip 96 of the contour nasal implant 
90 illustrated at FIG. 10 is substantially higher in shape and is 
essentially formed into a truncated pyramid. Also, the thickness of the 
dorsal support end or dorsal section 98 is substantially thinner in 
dimension relative to the dorsal support end or dorsal section illustrated 
in FIGS. 1 through 7. Further, the predetermined shaped tip 96 includes an 
outside edge 102 and the keel 100 includes an outside edge 104. In the 
embodiment illustrated in FIG. 10, the outside edge 104 of the keel 100 is 
substantially flush with the outside edge 102 of the predetermined shaped 
tip 196. 
FIGS. 1 through 11 are intended to show several possible embodiments of the 
contour nasal implant for practicing this invention. The surgeon can 
select a contour nasal implant having a selected predetermined shaped tip 
or a dorsal support end or a dorsal section having the desired thickness 
so that when the same is inserted into the nose of the patient, the 
desired profile and frontal views can be obtained and the desired 
elevation and reshaping of the nose can be obtained. 
FIGS. 12, 13 and 14 illustrate yet another embodiment of a contour nasal 
implant for practicing the invention. In the embodiment illustrated in 
FIGS. 12, 13, and 14, the contour nasal implant 110 has a substantial 
amount of material formed therein where a substantial amount of elevation 
is required in both the nasal dorsum area and in the nasal tip area. The 
contour nasal implant 110 includes the elongated central member 112 which 
has a fairly high, rounded predetermined shaped tip 106 and a 
significantly arcuate shaped and contoured dorsal support end or dorsal 
section 118. In addition, the contour nasal implant includes a keel 120 
which is located under the predetermined shaped tip 106. The length of the 
keel 120 extends substantially parallel to the elongated central member 
112. The contour nasal implant 110 further includes a septum strut 122 to 
provide extra elevation of the nasal tip when the same is required in 
order to obtain a desired shape and elevation of the nasal tip. In the 
embodiment illustrated in FIGS. 12, 13, and 14, the predetermined shaped 
tip 106 has an outside edge 112 and the septum strut 122 has an outside 
edge 124. The outside edge 112 or the predetermined shaped tip 106 and the 
outside edge 124 of the septum strut are substantially flush. The wedge 
120 can have its outside edge either spaced a predetermined distance in 
from the outside edge 112 or the predetermined shaped tip 106 in the 
manner illustrated in FIGS. 1 through 7 or can have its outside edge 
substantially flush with outside edge 112 of the predetermined shaped tip 
106 in a manner similar to the illustration of keel of FIGS. 8 and 10 
discussed hereinbefore. 
In connection with the contour nasal implant described in connection with 
FIGS. 1 through 14 hereinabove, the implant is preferably fabricated with 
a non-biodegradable, elastomeric material. In the preferred embodiment, a 
non-biodegradable elastomeric material is selected to be a silicone 
elastomer. One example of a silicone elastomer which can be utilized in 
practicing this invention is a material offered for sale and sold by 
Dow-Corning Corporation under the tradename Silastic, identified medical 
grade, ETR EALST, PT A. The elastomeric material selected for practicing 
this invention has a durometer rating of between about 75 durometers and 
about 20 durometers. In the preferred embodiment, the elastomeric material 
is selected to be a material having a durometer rating of about 35 
durometers. 
Referring now to FIGS. 15 through 19, these figures generally relate to 
certain of the steps used for the method of surgically implanting the 
contour nasal implant into the nose of a patient. 
In FIG. 15, the nose of the patient is shown generally as 140, and is 
typical of one of the type of nose of a patient for which a contour nasal 
implant as disclosed herein can be utilized. The nose 140 has a hanging 
tip 146 resulting in the nose that hangs towards the upper lip. The nose 
140 includes lateral lower cartilages 150 and a nasal bone which has a 
nasal dorsum 152 which extends to the in superior palpebral sulci 170 
shown generally by arrow 172. The nasal dorsum 152 terminates at the 
nasion, which is the point in the skull at which the suture between the 
two nasal bones meet in suture between the nasal bones and the frontal 
bone, and the nasion is shown generally as 144. The nasal tip 146 hangs 
from the lateral lower cartilages. In the embodiment illustrated in FIG. 
15, the nasal dorsum and nasal tip are to be elevated and are to augment 
the frontal and profile views of the patient nose 140. Thus, the first 
step of the surgical process starts with the surgeon drawing, onto the 
nose of a patient into which the contour nasal implant is to be surgically 
implanted, a line, shown as 172, which is used to connect the highest 
points of the superior palpebral sulci 170, such that the line crosses the 
nasal dorsum 152 at a point representing the nasion 144 and the highest 
point of implant insertion. 
Thereafter, the surgeon places two padgets in each nostril of the nose of 
the patient. Thereafter and as shown in FIG. 16, the surgeon then performs 
the step of making a rhinoplasty incision 186 into the skin located 
between the nostrils 180 of the patient's nose 178. 
FIGS. 17 and 18 depict the results of the next three steps which include; 
(1) retracting superiorly the columella skin off of the lower lateral 
cartilages 150 on each side of the nostril 180 up the highest point of the 
natural dome of the nose of a patient; 
(2) dissecting the skin off of the nasal dorsum of the nose to the line 172 
previously drawn across the nasal dorsum; and 
(3) implanting a contour nasal implant shown generally as 30, having an 
elongated central member having a first end and a second end, of which the 
predetermined shaped tip 50 as illustrated in FIG. 17, and the dorsal 
section 44 as illustrated in FIG. 18, such that the dorsal section is 
adapted to be positioned over the nasal dorsum 152 into the nose of a 
patient into which the same is implanted. The second end or dorsal section 
44 includes a predetermined shaped tip located on the same side of the 
elongated central member as the curvature of the dorsal section and 
further includes a keel 48 having a selected width and length which is 
located under the predetermined shaped tip 50. The keel 48 has a length 
which is generally parallel to the elongated central member such that the 
dorsal section 44 is positioned between the nasal dorsum 152 and the skin 
160 of the predetermined shape tip is located on the lower lateral 
cartilages 150. As illustrated in FIG. 17, the keel 48 extends downward 
between the lower lateral cartilage until the desired implantation 
position is obtained. 
As illustrated in FIG. 19, the next step is suturing the rhinoplasty 
incision between the nostrils 180 to implant the contour nasal implant 30 
within the nose of the patient to augment the frontal and profile views of 
the patient and to elevate the nasal tip 146 of the nose of the patient. 
The surgeon can perform a number of other ancillary steps which will 
include the following. The skin 160 in the area of the nasal dorsum can be 
sutured to the nasal dorsum 152 to ensure proper healing thereof. 
Preferably, the skin is sutured to the nasal dorsum by the use of a 
non-biodegradable suturing material. 
Also, it is preferable to use a biodegradable suturing material to suture 
the rhinoplasty incision in the skin between the nostrils of the patient. 
Preferably, the biodegradable suturing material can be catgut or some 
other suturing material having a high percentage of collagen as a part 
thereof, as is well known in the trade. Typical catgut that can be 
utilized for practicing in this invention is that described in the 
Physician's Desk Reference For Ophthalmology, PDR 15th Edition, Section 3 
thereof entitled "Suture Materials", pages 21 and 22. 
Thereafter, the surgeon can perform the step of removing the 
non-biodegradable suturing material from the skin and nasal dorsum after 
the nose has healed, ensuring that the contour nasal implant remains in 
position. 
During the surgical process, the surgeon can select the desired contour 
nasal implant having the characteristics described with respect to FIGS. 1 
through 14 hereof and, during the surgery, can hold the contour nasal 
implant relative the nose and trim any one of or all of the dorsal 
sections, the predetermined shaped tip and the keel prior to implantation 
of the same so that the desired contour and profile for the patient into 
which the same is implanted can be obtained. 
An example of the contour nasal implant surgery, including the steps taken 
by surgeons practice this invention, is set forth hereinbelow. 
EXAMPLE I 
The contour nasal implant is usually inserted under local anesthesia. A 
line is drawn with a marking pen connecting the highest points of the 
superior palpebral sulci. Where this line crosses the nasal dorsum 
represents the nasion and the highest point of implant insertion. The 
patient is given intravenously Versed 2.5 mg to 5 mg. Also, 1 mg of 
Robinul is given intravenously prior to prepping and draping. After 
marking, the patient is prepped with an iodinated skin antiseptic solution 
such as a BETADINE solution about the face while two BETADINE pledget (a 
compress or pad used to apply medication to or absorb discharges from a 
wound) are placed in each nostril. BETADINE is a trademark for iodined 
skin antiseptic. The generic name is povidone-iodine 7.5%. Just prior to 
the injection of local anesthetic 25 mg of Ketamine is administered and 
approximately one minute is allowed to lapse. 3 to 5 cc of 2% Xylocaine in 
1:e100,000 Adrenalin are then injected into the columella, the superior 
rim of the nostril corresponding to the lower border of the lower lateral 
cartilage on each side and the remainder along the dorsum of the nose 
lateral to the midline so as not to obscure the nasal profile. 
An open rhinoplasty incision made in the standard fashion. The columella 
skin is retracted superiorly, the skin is elevated carefully off the lower 
lateral cartilages on each side up to the highest point of the natural 
dome of the patient. If the patient has thin nasal skin, the soft tissue 
between the lower lateral cartilages is elevated with the skin to provide 
more padding for the implant. If the nasal skin is thick, then the skin 
only is elevated. Thick skin can be treated by removing the thickened 
undersurface of the skin scoring the skin horizontally to allow it to 
drape in a more favorable fashion. Care must be taken to not thin 
excessively or make the relaxing incisions too deep so as to allow the 
implant to extrude. Sharp scissors used to complete the dissection of the 
skin off the dorsum of the nose to the line previously drawn across the 
nasal bridge. A predetermined sized contour implant has been removed and 
has been soaking in BETADINE Solution. The implant is removed from the 
solution and held over the nose to approximate its implanted position. 
This allows for trimming of the implant to the proper length and to the 
proper nasal frontal angle for each patient. This trimming is necessary in 
90% of patient's. The tip of the implant should rest on the patient's 
lower lateral cartilages with the keel extending down between the lower 
lateral cartilages. Further trimming is required at the tip, usually on 
the sides to round off the implant where it rests on the lower lateral 
cartilages. The height of the newly formed tip can be adjusted by trimming 
the keel to the extent necessary. Once the implant is in position, it must 
be straight or must be trimmed accordingly. Contour can be checked by 
replacing the skin into its original position. Further stabilization of 
the implant is provided by passing a 5-0 nylon suture between the lower 
lateral cartilages through the keel of the implant. The skin is replaced 
and sutured into position with three 5-0 nylon sutures in the columella 
and multiple 5-0 chromic catgut sutures for the rim portion of the open 
rhinoplasty incision. 
Dressings consist of 1/4 inch Steristrips placed just posterior to the high 
point of the tip in a horizontal fashion and a vertical Steristrip placed 
from the base of the columella over the tip onto the dorsum of the nose. 
Preparing the skin with Mestasol aids in holding the strips for several 
days. Additional 1/2 inch tape can be placed across dorsum if there has 
been more bleeding than usual. The nylon sutures are removed in five days 
while the chromic sutures are allowed to dissolve by the twice daily 
application of antibiotic ointment in the nares. 
Although the preferred embodiment described herein is for a non-caucasian 
type implantation, variations thereof can be utilized with caucasians that 
have a similar problem. In certain instances the separate septum strut can 
be utilized with the highly flared end, as illustrated in FIGS. 12, 13 and 
14, where a large contouring is required for the nose. The septum strut 
can likewise be trimmed so that the desired shaping and elevation of the 
nose can be obtained. 
In the form of aesthetic rhinoplasty surgery, incisions are made on the 
nose inside the nostril to provide access to the lateral lower cartilage 
and nasal dorsum or bone, so that the implant can be inserted and the 
desired profile and frontal views and reshaping of the nasal tip can be 
accommodated to meet the needs and desires of the patient. The extent of 
the surgery and the required steps are a function of what changes are 
desired by the patient and what a surgeon deems appropriate with respect 
to performing the various steps of surgery. 
In post-operative recovery, the surgeon may find it necessary to use a 
splint. Also, the nasal packing may have to stay in the nose for several 
days before it is removed. 
The goal of performing aesthetic rhinoplasty surgery is to perform as much 
of the surgery as possible from inside the nose so there is no visible 
scarring or the like. If narrowing of the flared nostrils is required, it 
is envisioned that some outside incisions may be required, but a surgeon 
skilled in the trade will perform such an incision that the scar is barely 
visible in the crease of each of the nostrils. 
The degree of improvement desired by the patient can be achieved by 
utilizing the capability of the contour nasal implant to being trimmed or 
otherwise performed in a manner to obtain the desired elevation and 
reshaping of the nasal tip. The goal in performing such surgery and in the 
use of the contour nasal implant inside surgery is to create a "natural" 
look so that the surgery obtains the desired and pleasing aesthetic 
results, taking into the account the physiological structure of the 
patient's nose.