Rhinoplasty | definition of rhinoplasty by Medical dictionary Rhinoplasty | definition of rhinoplasty by Medical dictionary Definition The term rhinoplasty means "nose molding" or "nose forming." It refers to a procedure in plastic surgery in which the structure of the nose is changed. The change can be made by adding or removing bone or cartilage, grafting tissue from another part of the body, or implanting synthetic material to alter the shape of the nose. Rhinoplasty is the most frequently performed cosmetic surgical procedure in the United States as of the early 2000s. According to the American Society of Plastic Surgeons (ASPS), 356,554 rhinoplasties were performed in the United States in 2003, compared to 254,140 breast augmentations and 128,667 facelifts. Purpose Rhinoplasty is most often performed for cosmetic reasons. A nose that is too large, crooked, misshapen, malformed at birth, or deformed by an injury or cancer surgery can be given a more pleasing appearance.

If breathing is impaired due to the form of the nose or to an injury, it can often be improved with rhinoplasty. Precautions The best candidates for rhinoplasty are those with relatively minor deformities. Nasal anatomy and proportions are quite varied and the final look of any rhinoplasty operation is the result of the patient's anatomy, as well as of the surgeon's skill. The quality of the skin plays a major role in the outcome of rhinoplasty. Patients with extremely thick skin may not see a definite change in the underlying bone structure after surgery. On the other hand, thin skin provides almost no cushion to hide the most minor of bone irregularities or imperfections. A cosmetic change in the shape of the nose will change a person's appearance, but it will not change self-image. A person who expects a different lifestyle after rhinoplasty is likely to be disappointed. Rhinoplasty should not be performed until the pubertal growth spurt is complete, between ages 14-15 for girls and older for boys. The cost of rhinoplasty depends on the difficulty of the work required and on the specialist chosen.

Prices run from about $3,000 to over $6,000. If the problem was caused by an injury, insurance will usually cover the cost. A rhinoplasty done only to change a person's appearance is not usually covered by insurance. Description The external nose is composed of a series of interrelated parts which include the skin, the bony pyramid, cartilage, and the tip of the nose, which is both cartilage and skin. The strip of skin separating the nostrils is called the columella. Surgical approaches to nasal reconstruction are varied. Internal rhinoplasty involves making all incisions inside the nasal cavity. The external or "open" technique involves a skin incision across the base of the nasal columella. An external incision allows the surgeon to expose the bone and cartilage more fully and is most often used for complicated procedures. During surgery, the surgeon will separate the skin from the bone and cartilage support. The framework of the nose is then reshaped in the desired form. Shape can be altered by removing bone, cartilage, or skin. The remaining skin is then replaced over the new framework.

If the procedure requires adding to the structure of the nose, the donated bone, cartilage, or skin can come from the patient or from a synthetic source. When the operation is over, the surgeon will apply a splint to help the bones maintain their new shape. The nose may also be packed, or stuffed with a dressing, to help stabilize the septum. When a local anesthetic is used, light sedation is usually given first, after which the operative area is numbed. It will remain insensitive to pain for the length of the surgery. A general anesthetic is used for lengthy or complex procedures or if the doctor and patient agree that it is the best option. Simple rhinoplasty is usually performed in an outpatient surgery center or in the surgeon's office. Most procedures take only an hour or two, and patients may return home right away. Complex procedures may be done in the hospital and require a short stay. Preparation During the initial consultation, the patient and surgeon will determine what changes can be made in the shape of the nose. Most doctors take photographs at the same time. The surgeon will also explain the techniques and anesthesia options available to the patient.

For legal reasons, many plastic surgeons now screen patients for psychological stability as well as general physical fitness for surgery. When a person consults a plastic surgeon about a rhinoplasty, the doctor will spend some time talking with the patient about his or her motives for facial surgery. The following are considered psychological warning signs: The patient is considering surgery to please someone else, most often a spouse or partner. The patient expects facial surgery to guarantee career advancement. The patient has a history of multiple cosmetic procedures and/or complaints about previous surgeons. The patient thinks that the surgery will solve all his or her life problems. The patient has an unrealistic notion of what he or she will look like after surgery. The patient seems otherwise emotionally unstable. The patient and surgeon should also discuss guidelines for eating, drinking, smoking , taking or avoiding certain medications, and washing of the face. Aftercare Patients usually feel fine immediately after surgery; however, most surgery centers do not allow patients to drive themselves home after an operation. The first day after surgery there will be some swelling of the face. Patients should stay in bed with their heads elevated for at least a day. The nose may hurt and a headache is not uncommon. The surgeon will prescribe medication to relieve these conditions.

Swelling and bruising around the eyes will increase for a few days, but will begin to diminish after about the third day. Slight bleeding and stuffiness are normal, and vary according to the extensiveness of the surgery performed. Most people are up in two days, and back to school or work in a week. No strenuous activities are allowed for two to three weeks. Patients are given a list of postoperative instructions, which include requirements for hygiene, exercise , eating, and follow-up visits to the doctor. Patients should not blow their noses for the first week to avoid disruption of healing. It is extremely important to keep the surgical dressing dry. Dressings, splints, and stitches are removed in one to two weeks. Patients should avoid sunburn . Patients should remember that it may take as long as a year for the nose to assume its final shape; the tip of the nose in particular may be mildly swollen for several months. Risks Any type of surgery carries a degree of risk. There is always the possibility of unexpected events, such as an infection or a reaction to the anesthesia. Some patients may have a so-called foreign body reaction to a nasal implant made from synthetic materials.

In these cases the surgeon can replace the implant with a piece of cartilage from the patient's own body. Some risks of rhinoplasty are social or psychological. The ASPS patient brochure about rhinoplasty mentions the possibility of criticism or rejection by friends or family if they feel threatened by the patient's new look. This type of reaction sometimes occurs with rhinoplasty if the friends or relatives consider the shape of the nose an important family or ethnic trait. When the nose is reshaped or repaired from inside, the scars are not visible, but if the surgeon needs to make the incision on the outside of the nose, there will be some slight scarring. In addition, tiny blood vessels may burst, leaving small red spots on the skin. These spots are barely visible but may be permanent. About 10% of patients require a second procedure; however, the corrections required are usually minor. Resources Periodicals Chou, T. D., W. T. Lee, S. L. Chen, et al. "Split Calvarial Bone Graft for Chemical Burn-Associated Nasal Augmentation." Burns 30 (June 2004): 380-385. Daniel, R.

K., and J. W. Calvert. "Diced Cartilage Grafts in Rhinoplasty Surgery." Plastic and Reconstructive Surgery 113 (June 2004): 2156-2171. Honigman, R. J., K. A. Phillips, and D. J. Castle. "A Review of Psychosocial Outcomes for Patients Seeking Cosmetic Surgery." Plastic and Reconstructive Surgery 113 (April 1, 2004): 1229-1237. Raghavan, U., N. S. Jones, and T. Romo, 3rd. "Immediate Autogenous Cartilage Grafts in Rhinoplasty after Alloplastic Implant Rejection." Archives of Facial and Plastic Surgery 6 (May-June 2004): 192-196. Organizations American Academy of Facial Plastic and Reconstructive Surgery (AAFPRS). 310 South Henry Street, Alexandria, VA 22314. (703) 299-9291. American Society of Plastic Surgeons (ASPS).

444 East Algonquin Road, Arlington Heights, IL 60005. (847) 228-9900. Other [rī′nəplas′tē] Etymology: Gk, rhis + plassein, to mold a procedure in plastic surgery in which the structure of the nose is changed or shaped. Bone or cartilage may be removed, tissue grafted from another part of the body, or synthetic material implanted to alter the shape. After surgery any respiratory difficulty is reported immediately. The head of the bed should be elevated postoperatively. Frequent oral care is given, and ice compresses are applied to decrease the pain and edema that usually occur. Edema and discoloration around the eyes are expected to last for several days. The procedure is most frequently performed for cosmetic reasons. rhinoplasty Nose job, nose reconstruction Plastic surgery A procedure in which the size and/or contour of the nose is revised. Types–Esthetic–which constitutes the majority, and for which 25 000 are performed/year–US 70% in ♀; 11% < age 18.

Reconstructive–for defects caused by trauma or surgery to the region, most often related to extensive locoregional malignancy rhi·no·plas·ty Definition of Rhinoplasty Our Rhinoplasty Main Article provides a comprehensive look at the who, what, when and how of Rhinoplasty Definition of Rhinoplasty Causes of a Heart Attack Slideshow Rhinoplasty: Plastic surgery on the nose, known familiarly as a nose job. Rhinoplasty is a facial cosmetic procedure that is usually performed to enhance the appearance of the nose. During this type of rhinoplasty, the nasal cartilage and bones are modified, or tissue is added. Rhinoplasty is also performed to repair nasal fractures and other structural problems. In these cases, the goal is to restore preinjury appearance or to create a normal appearance. Last Editorial Review: 6/9/2016 Glossary of Terms Commonly Used in Primary & Revision Rhinoplasty Rhinoplasty FAQ Glossary of Rhinoplasty Terms Please note that some of the intra-operative photographs contained in this glossary are graphic and may be objectionable or disturbing to some viewers.

Use discretion when choosing whether or not to view these educational materials. The images are hidden by a warning message until hovered over with the mouse pointer. Ala (plural: Alae) Commonly called the nostril. The paired crescent-shaped convexities flanking the nasal tip that partially surround the nostril openings. The medial aspect of the ala is supported by the lateral crus of the alar cartilage. No cartilage is present in the outer portion of the ala. FIGURE 1 Topographic features of the nose; front and profile view. Alar Base The lower-most portion of the nose. Ideal width of the alar base is approximately equal to the inter-canthal distance (distance between the eyes), but may vary according to personal preference. The ideal alar rim configuration is often described as a "gull wing in flight". FIGURE 2 Alar base width approximates the inter-canthal space, and the nostrils mimic a "gull wing in flight" (shown in red). Alar Cartilages Also called the lower lateral cartilages. Paired (mirror image) arches of flexible nasal cartilage which govern the shape and strength of the columella, nasal tip, and alar rims.

Each arch is subdivided into the medial crus (columellar segment), intermediate crus (infra-tip segment), dome (lobular segment or tip-defining point), and lateral crus (alar segment). FIGURE 3 Schematic representation of paired alar (tip) cartilages (shown in blue). Profile (A) and base (B) views. Alar Retraction Also called notched ala or retracted ala. The cephalic mal-position of the alar rim. A common consequence of over-aggressive cephalic trim of the lateral crura, but may also be congenital. FIGURE 4 Example of severe alar retraction following over-aggressive rhinoplasty. Note excessive nostril show. Alar Rim The outer edge of the nostril opening as seen on front view, and the caudal border of the ala as seen on profile view (cephalad to the columella). Ideally, the alar rim is a gently curved, nearly straight line as seen on profile view. See Figure 1 Autologous Graft A piece of living tissue (e.g.

cartilage, bone, skin, etc.), harvested from the patient’s own body, for the reconstruction of a body part or appendage. In rhinoplasty, cartilage is commonly harvested from the nasal septum and used to reshape or reinforce the nasal tip or nasal bridge. Ear cartilage or rib cartilage may be used when preferable. Cartilage from each donor site has different physical properties, advantages, and disadvantages. Bony Vault The upper third of the nose (or upper half of the nasal bridge), composed of the paired nasal bones and the bony septum (vertical ethmoid plate). FIGURE 5 Schematic representation of the bony vault (upper nasal third), cartilaginous vault (middle nasal third) and alar cartilage (lower nasal third). Bulbous Tip A cosmetic nasal deformity characterized by a wide oversized nasal tip with large alar cartilage, often having broad rounded alar domes. FIGURE 6 A typical bulbous nasal tip. Note cupping of the widely spaced and broadly arched alar cartilages seen through thin overlying skin. Cartilage Graft Custom fabricated pieces of cartilage used to strengthen and/or reshape the nasal skeleton.

Cartilage grafts may be used to enhance nasal beauty, improve nasal breathing, increase structural stability, or combinations thereof. Cartilage grafts are employed in most forms of contemporary rhinoplasty. See also: Revision Rhinoplasty FIGURE 7 The non-essential portion of the cartilaginous septum (approximately one inch wide) harvested for graft fabrication. Note the comparatively small amount of cartilage available from the nose. Caudal Synonymous to caudad. Situated nearer to the nasal base (in nasal anatomy only). The opposite of cephalic or cephalad. Caudal Excess Deformity A naturally-occurring cosmetic deformity of the nasal base characterized by caudal over-growth of the nasal septum. Hallmark features are a hanging columella, a short upper lip, and webbing of the nasolabial angle. More commonly seen in Mediterranean and Middle-Eastern noses. FIGURE 8 Example of a classic caudal excess nasal base deformity before (A) and after (B) rhinoplasty. Note decrease in nasal length and corresponding increase in upper lip length. Cephalic Synonymous with cephalad (in nasal anatomy only).

In a direction toward the head. The opposite of caudal or caudad. Cephalic Trim Partial excision of the lateral crus along its cephalic border. A traditional rhinoplasty technique used in tip narrowing and tip rotation. A common cause of alar retraction and other tip deformities. FIGURE 9 Schematic representation of normal alar cartilage (A) and alar cartilage after cephalic trim (B). Closed Rhinoplasty Also called endonasal rhinoplasty. Refers to type of surgical access to the nasal skeleton associated with a relative lack of surgical exposure. Closed rhinoplasty avoids a visible columellar scar but restricts direct visualization and precludes many techniques currently used in open rhinoplasty. See also: Open vs. Closed Rhinoplasty FIGURE 10 Closed rhinoplasty in which both alar cartilages are being pulled out ("delivered") through the right nostril for suture modification (i.e., the "delivery" technique). Note the relative concealment of the nasal skeleton, the distortion of the alar cartilages, and the absence of a columellar incision.

Cocaine Nose A cosmetic nasal deformity resulting from cocaine abuse and subsequent cocaine-induced tissue necrosis. Hallmark features are a septal perforation, saddle collapse of the middle vault, and progressive deformity. In severe cases, loss of the entire nose and/or fatality may occur. FIGURE 11 Example of advanced cocaine nose deformity before (A) and after (B) surgical reconstruction with rib cartilage. Columella The central "column" separating the right and left nostrils as seen on base view, composed of skin and the paired right and left medial crura. See Figure 1 Columellar Show That portion of the columella visible on profile extending beyond the alar rim. Normal columellar show is 2-5 mm. FIGURE 12 Post-operative example of normal columellar show. Note columellar visibility approximately 3 mm beyond the alar rim. Columellar Strut A specific type of autologous cartilage graft used to increase tip projection, increase tip rotation, and/or enhance tip support. A concealed graft placed within the columella to stabilize the newly shaped nasal tip cartilage and prevent delayed deformity.

FIGURE 13 Schematic showing position of a columellar strut graft (shown in blue) between the right and left alar cartilages. Computer Imaging The process of modifying (i.e. "morphing") a patient’s digital photograph using computer software in order to visually simulate or "preview" various cosmetic changes to the nose for the purpose of clarity. See also: Computer Imaging Dorsal Pertaining to the nasal dorsum or nasal bridge (in nasal anatomy only). Edema Excessive lymphatic or serous fluid permeation of the soft tissues, typically in response to tissue trauma or disease states. May persist up to 18 months following rhinoplasty in extreme cases. Chronic edema may lead to permanent fibrosis. Ethnic Rhinoplasty A term coined to describe cosmetic rhinoplasty in individuals of minority ethnic descent. See also: Ethnic Rhinoplasty Excisional Rhinoplasty A term used to describe the traditional method of reduction rhinoplasty in which cartilage excision is the sole means of contour alteration. Although still widely used today, the excisional method is associated with a significantly higher rate of contour and functional deformities. See also: Incisional vs.

Excisional Rhinoplasty Fibrosis The formation of fibrous (scar) tissue as a reparative or reactive process in organs or tissues not normally containing fibrous tissue. A common sequela in thick-skinned or scar-prone rhinoplasty patients. Functional Rhinoplasty A term used to describe surgical reconstruction of the nasal airway to restore nasal function. See also: Functional Rhinoplasty Hanging Columella A cosmetic nasal deformity characterized by an overly-protruding columella, resulting in excessive columellar show on profile view. FIGURE 14 Example of a naturally-occurring "hanging" columella. Note excessive nostril visibility from caudal over-growth of the nasal septum. Hypertrophic Scar An overactive wound healing response to cutaneous injury or surgery, resulting in an unsightly raised and widened scar. Unlike keloids, a hypertrophic scar usually responds to timely treatment. Inferior Situated toward the bottom or below. Situated nearer the soles of the feet in relation to a specified reference point. The opposite of superior. Infra-tip Lobule The lower-most portion of the nasal tip found immediately above the nostril openings (See Figure 1).

The infra-tip lobule is formed by the paired (divergent) intermediate crura of the alar cartilages. See Figure 15 Intermediate Crus (plural: Crura) The segment of alar cartilage found above the nostril and below the nasal dome, corresponding to the infra-tip lobule. FIGURE 15 Schematic of the intermediate crura (shown in yellow) from the profile (A) and base (B) views. Intermediate Osteotomy A modified traditional bone cut positioned midway between the medial and lateral osteotomy cut. Used to reshape misshapen, indented, or cupped nasal bones. Inverted-V Deformity A nasal bridge shadow deformity resulting from excessive narrowing of the middle vault cartilage relative to the adjacent nasal bones. A type of step-off deformity resulting from over-aggressive nasal hump reduction or blunt nasal trauma. FIGURE 16 Example of inverted-V deformity. Note inverted V-shaped shadow formed by middle vault pinching after over-aggressive hump reduction. Keloid A severe overactive wound healing response to cutaneous injury or surgery, resulting in a stubborn tumor-like accumulation of fibrous (scar) tissue. Often difficult or impossible to treat in susceptible individuals.

Kenalog The brand name of triamcinolone acetate, an injectable synthetic steroid used to prevent prolonged edema and unwanted fibrous (scar tissue) formation. Lateral Farther from the midline or mid-sagittal plane. Toward the outer perimeter. The opposite of medial. Lateral Crus (plural: Crura) A sub-component of the alar (tip) cartilage. The lateral crus extends obliquely immediately above the alar crease from the nasal dome (medially) to the pyriform aperture/cheek (laterally). FIGURE 17 Schematic of the lateral crura (shown in turquoise) from the profile (A) and base (B) views. Medial Closer to the midline or mid-saggital plane. Near the middle. The opposite of lateral. Medial Crus (plural: Crura) The caudal/inferior most segment of the alar cartilage corresponding to the columellar segment. FIGURE 19 Schematic of the medial crura (shown in purple) from the profile (A) and base (B) views.

Medial Osteotomy A para-sagittal bone cut, placed immediately adjacent to the sagittal midline, for medial repositioning (infracture) of wide nasal bones. Used in tandem with lateral osteotomy for complete infracture. See Figure 18 Middle Vault The middle third of the nose (and the lower half of the nasal bridge). Composed entirely of cartilage, the middle vault is formed by the mid-line dorsal septum and the right and left upper lateral (sidewall) cartilages. See Figure 5 Nasal Domes The hinge-point (apex) of each alar cartilage formed by the junction of the intermediate and lateral crus. The tip-defining point. FIGURE 20 Schematic of the nasal domes (shown in red) from the profile (A) and base (B) views. Nasal Dorsum Synonymous with nasal bridge. The upper two-thirds of the nose consisting of the middle (cartilaginous) vault and the upper (bony) vault. Nasal Implant A non-living, synthetic material used to replace missing or damaged nasal tissues. Although sometimes controversial, nasal implants are still used routinely.

Nasal Tip Also called the lobule. The forward-most part of the nose, formed by the alar domes, flanked on either side by the alae. Subdivided into the tip lobule, supra-tip lobule, and infra-tip lobule. See Figure 1 Nasal Valve The natural anatomic "bottleneck" of the nasal airway which regulates nasal airflow through alternate swelling and contraction of the septal and turbinate mucosa found on its inner surface. Anatomic obstructions to nasal airflow are most common in the nasal valve area due to its naturally small size. Cosmetic nasal surgery is a common cause of nasal valve dysfunction. FIGURE 21 Schematic cross-section of the nose taken through the nasal valve area (A) demonstrating the small cross-sectional area and partial obstruction by the inferior turbinate head (B). Nasofrontal Angle The angle formed between the nasal bridge and the forehead (glabella) as seen on profile view. Ideally the apex (or nasal starting point) is situated at the level of the superior eyelash line. Nasolabial Angle The angle formed between the columella and the upper lip as seen on profile. Typically more obtuse in females.

See Figure 22 FIGURE 22 Profile aesthetics of the nose. Necrosis Tissue death resulting from inadequate oxygenation, usually a result of disrupted blood flow. Open Rhinoplasty Open, or external, rhinoplasty refers to a more aggressive surgical exposure of the nasal skeleton. With the aid of a small but visible skin incision on the columella, open rhinoplasty offers direct visualization of the nasal skeleton. Most experts regard open rhinoplasty as more versatile, and the exposure of choice for complex anatomy or revision rhinoplasty. In expert hands, the columellar scar is often invisible. See also: Open vs. Closed Rhinoplasty FIGURE 23A Incision placement for open rhinoplasty. Note the V-shaped trans-columellar incision extending inside the nostril. FIGURE 23B Typical skeletal exposure obtained using open rhinoplasty. Note direct visualization of the undistorted nasal framework. Open Roof Deformity Gapping of the nasal bones following dorsal hump reduction resulting from over-aggressive hump reduction and/or failure to completely infracture the nasal bones. Percutaneous Osteotomy Also called postage-stamp osteotomy.

A type of lateral osteotomy employing a series of side-by-side bone cuts made through a single small skin incision. Thought to be less difficult than the traditional (endonasal) lateral osteotomy, but with the potential for a visible scar. Pinched Lobule Excessive narrowing of the nasal tip secondary to medial collapse of the alar domes. A frequent consequence of over-aggressive alar cartilage removal and/or over-aggressive tip sutures. FIGURE 24 Example of pinched lobule (tip). Note unsightly vertical flattening of the nasal tip. Primary Rhinoplasty Primary rhinoplasty refers to a previously unoperated nose or first-time rhinoplasty. Primary rhinoplasty is not hindered by previous surgical scarring of the soft tissues or previous surgical damage to the nasal cartilage or bone. Radix The nasal root. The upper termination of the nasal bridge at the glabellar base. A soft tissue landmark which roughly corresponds to the deepest point of the nasal bone (i.e., the nasion).

See Figure 1 Retracted Columella A columellar deformity characterized by little or no columellar show, resulting from inadequate columellar projection secondary to over-aggressive cosmetic surgery, nasal trauma, or birth deformity. FIGURE 25 Example of retracted columella with minimal columellar show before (A) and after (B) correction. Rhinion Junction of the bony upper nasal vault with the cartilaginous middle nasal vault. The typical high point of a nasal bridge hump. See Figure 1 Rotation Term used to describe tip position along a fixed arc of rotation. A "rotated tip" rests closer to the forehead and appears perky, whereas a counter-rotated tip is positioned away from the forehead and may appear droopy. Ideal tip rotation varies according to personal preference. FIGURE 26 Schematic representation of tip rotation. Saddle Nose Deformity A cosmetic and functional nasal deformity resulting from collapse of the middle vault. Causes include autoimmune disease, cocaine abuse, blunt trauma, and over-aggressive cosmetic nasal surgery. FIGURE 27 Example of auto-immune-induced saddle nose deformity before (A) and after (B) rib graft reconstruction.

Secondary Rhinoplasty Secondary or revision rhinoplasty refers to re-operation of a previously operated nose. Secondary rhinoplasty may be performed for cosmetic and/or functional enhancement. Revision rhinoplasty is generally regarded as one of cosmetic surgery’s most difficult operations owing to pre-existing skeletal damage and soft tissue scarring. In general, the recovery is slower and the outcome less dramatic relative to a well-executed primary rhinoplasty. See also: Revision Rhinoplasty Septum The dividing wall separating the right and left nasal passages, formed by cartilage or bone and covered on both sides with nasal mucosa. Septal Extension Graft A type of columellar strut graft attached to the caudal septum for maximum support. Commonly used to lengthen short noses. Shield Graft A type of infra-tip cartilage graft fixed to the alar cartilages in order to counter-rotate and/or increase tip projection. FIGURE 28 Schematic representation of a shield-type augmentation graft (shown in yellow) placed in the infra-tip lobule.

Spreader Graft A middle vault augmentation graft placed between the dorsal septum and the upper lateral cartilage(s) to increase middle vault width, improve symmetry, increase airway dimension, and/or straighten the dorsal septum. FIGURE 29 Schematic representation of bilateral spreader graft (shown in red). Placement of graft in middle vault straightens curvature of the dorsal septum. Structural Rhinoplasty A philosophical approach to both cosmetic and functional rhinoplasty, in which nasal framework is artfully reconfigured to enhance beauty, and then structurally reinforced to ensure lasting results. The philosophical opposite to excisional rhinoplasty, a traditional approach in which structural support is compromised, leading to a high probability of progressive deformity. See also: Incisional vs. Excisional Rhinoplasty Superior Situated toward the top or above. Situated nearer to the vertex (top of the head). The opposite of inferior. Supra-Tip Break Also called retroussé (pronounced reh-troo-SAY). A naturally-occurring variation in height between the nasal tip and the adjacent nasal bridge (as seen on profile). A common topographic feature in feminine noses often sought in cosmetic nasal surgery.

The ideal tip retroussé varies according to personal preference and can be modified accordingly. FIGURE 30 Examples of post-operative supra-tip retroussé, ranging from mild (A) to pronounced (B). Tension-Nose Deformity A naturally-occurring cosmetic deformity characterized by dorsal overgrowth of the nasal septum. Hallmark features include "pollybeak" overgrowth deformity of the nasal bridge, overprojection of the nasal tip, and a wide nasal pedestal. FIGURE 31 Example of a classic tension nose deformity, as seen on profile view. Note overprojected tip and pollybeak deformity (overprojected middle vault). Tip Projection rhinoplasty - definition of rhinoplasty in English | Oxford Dictionaries Definition of rhinoplasty in English: rhinoplasty [mass noun] Plastic surgery performed on the nose: ‘rhinoplasty to straighten the nose’ [count noun] ‘the operation was more costly than a simple rhinoplasty’ More example sentences ‘After all, we're not talking bronzer and rhinoplasty here.’ ‘Dr. Goldman's enthusiasm for rhinoplasty was intriguing to Dr.

Simons.’ ‘Seltzer investigated two different doses of bromelain in patients undergoing rhinoplasty.’ ‘This paper has not explored the nuances of varying angles for lateral views but the experienced rhinoplasty surgeon is only too aware that small angle changes on the lateral view can emphasize or de-emphasise small dorsal humps.’ ‘Breast implants are common, as are cheek implants and rhinoplasty.’ ‘For instance, if I'd worn a metal nose cone throughout my childhood I might have saved myself thousands of pounds in costly rhinoplasty.’ ‘Young teenagers, the group which is most taken up with its own appearance, are not ideal candidates for rhinoplasty, or most cosmetic surgery for that matter.’ ‘Each procedure involved a teenager having rhinoplasty.’ ‘For Tailia Santo, the rhinoplasty that changed her nose wasn't her first surgery; she had already had breast implants.’ ‘Sinus surgery was the majority of his cases, but he did some rhinoplasty.’ ‘The reality is that rhinoplasty surgeons will continue to display pre- and post-operative photographs that inadvertently misrepresent their results.’ ‘Other surgeries can include: suction-assisted lipoplasty of the waist, rhinoplast

y, facial bone reduction, face-lift, and blephroplasty.’ ‘Asian rhinoplasty is different to other parts of the world.’ ‘In the TV version, contestants are made-over from head to toe, from liposuction to rhinoplasty.’ ‘Other procedures available are otoplasty (ear correction), rhinoplasty, liposculpture, penile enhancement and face, neck and brow lifts to name but a few.’ ‘The rhinoplasty her Daddy bought her for her Sweet Sixteen went horribly awry and left her with a nose looking like something out of Star Trek.’ ‘The doc says it's no worry 'cause it is a common aftereffect of rhinoplasty and should go away pretty soon.’ ‘For instance, a classic rhinoplasty in China aims at making the nose higher by using nasal implants.’ ‘To resemble Pitt, the brothers undergo rhinoplasty, receive chin implants, and obtain porcelain veneers.’ ‘They both get rhinoplasty, chin implants and porcelain veneers, in the hopes that all the facial overhauling - and massive pain that they suffer - will ultimately help them with their dreams of becoming movie stars.’ Pronunciation: Which of the

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Tears coursed down her cheeks Tears coarsed down her cheeks Which of the following is correct? I had steak for my main course I had steak for my main coarse Which of the following is correct? She was a course-looking woman She was a coarse-looking woman Which of the following is correct? The ship changed coarse Which of the following is correct? Her illness had run its course Her illness had run its coarse Which of the following is correct? He had a head full of course hair He had a head full of coarse hair Which of the following is correct? He changed the coarse of history He changed the course of history Which of the following is correct? Of course I care about you Of coarse I care about you Which of the following is correct? He wore a shirt of coarse cloth He wore a shirt of course cloth Which of the following is correct? The college runs language courses The college runs language coarses You scored /10 practise again? Retry Most popular in the world Australia Ethnic Rhinoplasty Information - Chicago Nose Surgery What’s New Ethnic Rhinoplasty Although I am frequently asked about “ethnic” rhinoplasty by patients, the definition of an ethnic rhinoplasty is relative and varies greatly based on perspective.

What someone in Chicago considers an ethnic rhinoplasty may be different from what is thought to be “ethnic” in Los Angeles, Miami or Maine. Recently I was in Tokyo and Seoul discussing my techniques for Asian rhinoplasty, and when my colleagues asked me about ethnic rhinoplasty, they were referring to a Caucasian nose. Cosmetic rhinoplasty has its roots in the early part of the 20th century and began as an operation that would allow someone to hide their ethnicity. It was on operation popularized in Germany by Dr. Jacques Joseph for Middle Eastern, Eastern European and Russian descendants who wanted a more German looking nose. The operation quickly caught on in America when pioneering and forward thinking American surgeons including my great uncle Sam Fomon, went to learn from Dr. Joseph. They brought back this curious image altering procedure, and it gained popularity in NYC especially among the Irish and Jewish immigrants wanting to appear more American. The “American nose” was shorter scooped out tiny tip nose typified by twiggy the American iconic star of the 50’s. The goal was still to hide one’s ethnicity. However, America started to change as many more immigrants moved to this country and the appearance of what is beautiful also changed.

Beauty in a population is defined by what is the average of all the people in that group. So as America absorbed more peoples from Africa, South America and Asia our definition of what is beautiful also migrated. Today what is beautiful is no longer a turned up nose, wide open eyes or well defined lips rather it is fuller eyes (Catherine Zeta Jones), a slightly wider nose (Halle Berry) and fuller lips (Anjolie Jolie). Our goal today is rather to create a more symmetric nose that blends with the average of society but still allows for identity of one’s original ethnic roots. It is uncommon for a person to ask for a race-changing nose today although on occasion it happens. Most patients just want their nose, but better, one they can feel proud of whether at their family reunion or at their multicultural college campus. The aesthetics of the nose do vary based on region and culture, so it is critically important to be very sensitive and understand the goals of each individual. My first 5 years of performing rhinoplasty were on patients of African American and Asian descent. Over the last ten years, I have gained enormous experience operating on such noses and have developed unique techniques to preserve ethnicity and keep the procedure a secret.

It seems especially important for my patients who are in the media spotlight whose career could be ruined if the fact they had a rhinoplasty became public. Patients of African, Hispanic and Asian descent tend to have thicker skin, wider nasal bases, limited caudal septal support and a lower dorsum (bridge). A common request is a higher bridge (dorsum), narrowed tip and narrowed nostril base. However the techniques that would achieve such results in a Caucasian nose are completely different for an ethnic nose. The bridge while appearing wide will not be narrowed by breaking the nose, (lateral osteotomies) rather the bridge has to be augmented. In Asia, foreign body grafts such silastic implants and fillers are popular. In the United States, however, these are less popular as we tend to be concerned about the infection and rejection rates associated with these products. We tend to use cartilage and soft tissue materials that come from the patient’s nose, ear or rib. Therefore there is no chance for rejection. Yes it does take more time but in the long run it may be a better solution. The nasal tip in order to be narrowed needs more projection and support.

“Ethnic” noses tend to have thin lower lateral (tip) cartilages and weak support to the tip. In other words if you push on the tip it is easily depressed almost all the way down and springs back slowly. In order to provide thinning and more definition to the tip it will need support usually achieved with a caudal septal extension graft and tongue in groove maneuver. These are stabilizing grafts that use the patient’s own septal cartilage. For more information on these grafts see my lecture to the Australian Society of Facial Plastic Surgeons. Often the lower lateral cartilage and tip will need additional augmentation and this can be achieved with soft tissue and fascia taken from behind the nose or if additional is needed from behind the ear. Because the “ethnic” nose tends to have thicker skin and is at higher risk for swelling and scaring, a closed rhinoplasty approach with all incision hidden on the inside of the nose is particularly favored and beneficial. Nothing could be worse than a nicely shaped nose ruined by a horrible scar on the columellar (skin between the nostrils). Additionally keeping swelling to a minimum is essential.

Excess swelling can lead to permanent changes in the nose such as poly beak formation (nose looks like a parrot beak). It is my opinion that the closed approach with less surgical dissection and quicker operative times is very important to reducing the risk for post operative swelling. There are multiple other measures that I use during surgery to reduce the risk of swelling from smaller instruments, to specific medications given during surgery and special stitches. All of these seemingly minor steps are very important swelling reduction maneuvers that I have learned and developed over years from performing and teaching of ethnic rhinoplasty. If you are considering undergoing a rhinoplasty and are of ethnic descent, make sure your physician is very experienced with treating people with noses similar to yours. Ask to see photos, talk to other patients and ask for your doctor’s philosophy on “ethnic rhinoplasty.” questions to ask before undergoing ethnic rhinoplasty, in addition to “The 15 Rhinoplasty Questions.” How many ethnic noses have you done? What measures do you use differently from Caucasian noses? Do you use grafting material that is a foreign? Will you break my nose? Are you worried about scarring in my nose? What will you do to prevent excessive swelling?

Do you do the closed approach and if not why? Common Conditions: Rhinoplasty Risks - Side Effects, Complications, Dangers updated September 26, 2014 When considering any type of surgical procedure, it is important to understand the risks associated with the surgery. Rhinoplasty is one of the most common cosmetic surgeries performed each year, but it carries the same potential risks as all other operations. While achieving your aesthetic goals is ideal, maintaining your overall health should be the top priority of you and your surgeon. Although most rhinoplasty procedures are problem-free, patients should educate themselves on the potential side effects and risks of rhinoplasty, as well as their own personal risk factors. Discussing these risks with an experienced, board-certified surgeon is vital to ensuring a healthy outcome. Surgery Risks When it comes to understanding the risks of plastic surgery, it is important to consider those associated with any surgery, as well as the dangers of the specific procedure. These risks apply to revision and ethnic rhinoplasty as well and should be discussed in full detail with your surgeon, prior to receiving surgery.

The potential rhinoplasty risks associated with all surgeries include: Bleeding Permanent nerve damage Under-or over- correction that necessitates revision rhinoplasty. Choosing a qualified cosmetic surgeon can significantly reduce the health risks associated with rhinoplasty. Patients should use their consultation as an opportunity to ask questions about the procedure, including its risks, benefits, and side effects. In addition, following your surgeon’s instructions for pre-and post-surgery care will help to avoid health complications. RELATED: Find a qualified facial plastic surgeon in your area Side Effects In addition to health risks associated with the rhinoplasty procedure, there are a number of potential short-term side effects. Because rhinoplasty surgery is a highly individualized procedure, the side effects experienced will vary by each patient. Taking a moment to learn about these side effects- what they are and how long they’ll last- should help you feel more confident about this important decision, and more comfortable about the outlook for your rhinoplasty procedure. Pain after Surgery Nose surgery is one of the most powerful ways to enhance your appearance. However, because it requires extensive alterations of nasal bone and cartilage, patients may experience pain or discomfort following the procedure.

Fortunately, this discomfort is usually minor and most patients find that over-the-counter analgesics are enough to manage this pain. For patients who are particularly sensitive to pain, your rhinoplasty surgeon may be able to prescribe stronger pain medication. Swelling One of the most common side effects from rhinoplasty is swelling around the eyes and nose. The swelling is most noticeable in the days following surgery, but largely subsides after about two weeks. It is important to note, however, that some minor swelling may be present for up to six months following rhinoplasty surgery. The final results of rhinoplasty are typically seen in one year. Bruising Bruising is another side effect that is often associated with rhinoplasty. The degree of bruising that follows surgery will vary depending on patient sensitivity and the extent of the surgery itself. This bruising is usually contained to the area around the eyes and can last for up to ten days. While bruising is not a sign of any more serious complications, you should monitor your condition in the days following surgery. If anything seems abnormal, your physician can advise you as to whether any measures besides rest and time are necessary during your rhinoplasty recovery.

Visit the DocShop gallery to view rhinoplasty before and after photos . Photo credit: Minas Constantinides, MD, FACS, PC Many Patients Want to Know ... Is there scarring after a nose job? Yes, there is scarring after rhinoplasty, but most people will not be able to see it. Closed rhinoplasty creates an incision on the inside of the nostrils, where the scars will be completely hidden. The less common open rhinoplasty procedure creates one small incision in the skin separating the two nostrils. This cut usually heals very well, leaving behind only a very fine scar that most people will not notice. With either type of nose job, permanent outward marks should be minimal at most. Learn more about the different types of rhinoplasty procedures. Contact a Surgeon Rhinoplasty (Nose Job) Surgery Procedure, Recovery, Complications, and More Nose Job Recovery Nose Job Basics A nose job (technically called a rhinoplasty ) is surgery on the nose to change its shape or improve its function. It can be done for medical reasons -- such as to correct breathing problems related to the nose or correct disfigurement resulting from trauma or birth defects .

It can also be done for cosmetic reasons, which will change the nose's shape and appearance. Deciding on a Nose Job If you are thinking about getting a nose job, set up an appointment with your surgeon to discuss it. During that meeting, talk about your goals and tell the doctor what bothers you about your nose and how you would like to change it. Keep in mind that there is no such thing as a perfect nose. Surgery, though, can enhance facial features and emphasize your unique and natural beauty . A plastic surgeon can describe the facial features that make you unique and tell you how changes would enhance your appearance. The surgeon will evaluate the structures of your nose and other facial features. After this evaluation, he or she can tell you if your expectations are realistic. The surgeon will also consider your overall health and should discuss with you the risks, recovery time, and costs involved. There are various techniques for reshaping the nose. Once you decide to go ahead, your surgeon should describe exactly what he or she proposes to do. If you have health insurance , make sure you talk to your insurer in advance so you know what's covered and what you will need to pay for. Health insurance typically does not pay for procedures that are done only for cosmetic reasons.

Rhinoplasty: Step-by-Step A nose job is usually done as an outpatient procedure, meaning there is no overnight stay. You'll get general or local anesthesia. With general anesthesia, you'll sleep through the operation. With local anesthesia, you will be sedated and your nose will be numbed so you are relaxed and unable to feel the pain. During an operation, the surgeon makes cuts within the nostrils. In more difficult cases, the surgeon may also make cuts across the base of the nose. The surgeon then reshapes the inner bone and cartilage to produce a more pleasing appearance. Continued Nose Job Recovery After a nose job, people usually wear a nasal splint for the first week. You can expect swelling and some bruising around the eyes after surgery that will begin to improve after the third day. It can, though, last up to two weeks. Expect your nose to have a little swelling, which probably only you and your surgeon will notice. This will go away over the next six months. The final shape of your nose will be apparent after it has completely healed. You should avoid strenuous activity for three to six weeks after surgery.

You may return to your social activities as soon as within two to three weeks without any recognizable signs that you had a procedure done. WebMD Medical Reference Reviewed by Debra Jaliman, MD on January 13, 2016 Sources Issues Following Primary Rhinoplasty | Rawnsley Plastic Surgery Issues Following Primary Rhinoplasty Issues Following Primary Rhinoplasty Rhinoplasty is a complicated and delicate surgery with both aesthetic and functional aspects that take years of surgical experience to master. For this reason, regrettably, revision rates are very high. As a top specialist in the field, Dr. Rawnsley encounters a variety of problems that can result when rhinoplasty is performed by less experienced surgeons. Each problem requires its own specific corrective treatment. Some of the most common problems Dr. Rawnsley corrects include: Bridge and Central Nose Problems Polly Beak Deformity-Cartilaginous or Soft Tissue Revision Patient #1 In a natural-looking nose, there is a slight depression as the nose transitions from the bridge to the tip. In the case of the polly beak deformity, however, this bridge area above the tip is too high, giving the nose an appearance like a parrot's beak.

Three different complications during rhinoplasty can lead to this problem, which is one of the most common seen after rhinoplasty surgery. A cartilaginous polly beak deformity occurs when too much cartilage is left after surgery. Revision rhinoplasty in this case involves shaving down the extra cartilage. A soft tissue polly beak deformity occurs when a surgeon removes too much soft tissue on a patient with thick skin so the skin doesn't properly contract and flatten out, causing excessive scar tissue to form in the area. In this situation, corrective surgery involves removal of the scar tissue and the proper placement of an absorbable suture or skin tape to make sure the skin redrapes and heals appropriately. In the third type of polly beak deformity, the original surgeon fails to leave enough support for the tip of the nose and it droops over time, making the area above the tip appear to project too far. Revision rhinoplasty to address the problem requires the surgeon to reconstruct the nasal tip so it has adequate support.

Profile Deformity: Persistent Bump or Scooped Out Bridge Revision Patient #3 Two post-operative profile deformities can result when a rhinoplasty attempts to address a bump (or bumps) in the nose. In the situation of the "persistent bump," the surgeon fails to completely smooth all of the bone or cartilage of the nose. In the contrasting case of a "scooped out bridge," the surgeon misjudges and takes out too much bone, leaving the patient with an area that looks "scooped out" in his or her profile and too washed out from a front view. Revision rhinoplasty to address a persistent bump requires additional smoothing with a nasal rasp, a precise tool that allows for an extremely controlled removal of the problematic bone or cartilage. Correcting a scooped out bridge requires build up of the missing area with the patient's own cartilage. Collapsed Central Nose: Middle Vault / Inverted "V" Deformity and Internal Valve Collapse The "Middle Vault," also known as the "Inverted V Deformity," occurs when a bump is removed from the central nose, but inadequate support is provided.

The center of the nose collapses, both inhibiting breathing and making the nasal bones visible to the naked eye in the shape of an inverted "V." Breathing will also be inhibited when the removal of a bump causes the collapse of the narrowest area inside the nose, the internal nasal valve. As with a scooped out bridge, a revision rhinoplasty to address a collapsed central nose or internal valve collapse involves rebuilding the missing area with the patient's own cartilage. Irregular Bridge or a Poor Bridge to Tip Relationship Revision Patient #4 Other general aesthetic concerns relating to the bridge can occur after a rhinoplasty procedure. At times, the problem is simply that irregularities appear in how the bridge heals after the removal of a bump. In addition, there can be issues with the middle one third of the nose, called the central nose. The central nose forms the transition from the bridge to the tip and must be in proper proportion to seamlessly blend the two together in an aesthetically harmonious relationship. If any of the three parts are out of balance, the final result will be unsatisfactory.

Deviated Nose Issues Revision Patient #7 A deviated nose is a nose with twist-either in the upper, middle, or tip of the nose. It is one of the most difficult problems to address through rhinoplasty and can persist after a original rhinoplasty or a revision rhinoplasty. It can even be introduced through a rhinoplasty or revision rhinoplasty procedure. A frequent cause of a pre-existing deviation is crooked nasal bones. When the problem is introduced through surgery, it is sometimes because the efforts to remove a bump or other issue cause bones to shift. The techniques to address deviations vary widely depending on where the twist occurs and all the details are highly technical. If your problem involves a deviation in the nose, please discuss it with Dr. Rawnsley one-on-one, for an expert analysis of your particular situation and the best approach to address it. Tip Problems Pinnochio Deformity/Overprojected Tip One of the most common mistakes seen following rhinoplasty is the over-protected tip. Once a prominent bump is removed, patients often discover that the tip of the nose projects too far from the face.

The problem can be exacerbated if the bridge of the nose slopes too much post-surgery. In many cases, surgeons simply do not dare tackle the issue of the over-protected tip during a rhinoplasty because the techniques to deproject the tip are highly technical and require advanced skill and a deep well of experience. The surgeon would rather avoid the procedure entirely than risk reducing the tip too much. In addition, it is practically impossible to meaningfully reduce the tip in a standard "closed" rhinoplasty procedure. Only an "open" procedure, such as those performed by Dr. Rawnsley (where the flesh between the nostrils is cut), can effectively achieve true deprojection of the tip. The good news is that once a proper open procedure has been performed the structural support for the tip of the nose is far stronger than it would have been without revision rhinoplasty. Overly Shortened Nose/Over-Rotated Tip Overresection is the technical term applied when too much of the supporting structure for an area of the nose is removed during a rhinoplasty. The problem can lead to several tip-related abnormalities.

If an overresection occurs in the front end of the septum (the structure dividing the two nasal cavities), the tip of the nose can fall backward, causing an overly shortened appearance where the tip is over-rotated upward, like a "pig's snout." Correcting this problem requires the restoration of proper supporting structures in the septum. Droopy Tip/Under-Rotated or Poorly Supported Tip Conversely, overresection can also lead to the opposite problem where the tip of the nose droops, called a ptotic tip. In this situation, too much of the tip's support structure cartilage is removed and the end of the nose collapses downward. To lift the tip and correct the problem, the revision rhinoplasty surgeon must rebuild the weakened or missing underlying structure and thus restore support strength to the tip. Tip Bossae (Knuckling) If the two projecting points of cartilage that support the nose tip are too aggressively removed they will lose their springy structure and remaining cartilage will begin to bend and twist.

This causes a problem called "bossae" or "knuckling" where the cartilage turns upon itself and the weakest points at the joints of the cartilage form very noticeable bumps or "knuckles." Attempting to trim these knuckles as some surgeons do will only further weaken the tip structure in the long term. Instead, the entire tip structure must be reconstructed so it has the strength to last the test of time. Asymmetric Tip It is important to remember that whenever a rhinoplasty is performed, it involves two separate procedures, one to the right side of the nose and one to the left. In every stage of the surgery, great attention must be paid to symmetry. The cartilage on both sides of the nose tip must be removed to exactly the same degree or and asymmetric tip will result. Asymmetries may also occur due to unequal scarring during the healing process and not reveal themselves until months or even years after the fact. For a successful revision rhinoplasty, the surgeon must pay careful attention to symmetry at every stage of the procedure and through extensive experience anticipate how the scar tissue is likely to form and adjust accordingly for a final, aesthetically satisfying result.

Pinched Tip Rhinoplasty procedures using open technique (where the flesh between the nostrils is cut) is an innovation of the last decade. Before that "reductive" rhinoplasty was performed with closed technique, a much simpler approach where cartilage and bone were quickly removed to narrow and shrink the nose, allowing the entire procedure to be completed in about half an hour. Unfortunately, when this approach is used, over time the skin, the soft-tissue envelope, and areas of scar tissue around the nose invariably contract and can look distorted. One of the most common defects and a telltale sign of this style nose job is the "pinched tip," where too much tip cartilage was removed. Revision rhinoplasty to correct the problem involves the restoration of cartilage to restore proper fullness to the tip. Unitip Deformity A "unitip deformity" is the term given to the problem where the two points of cartilage (like two wings) that form the nose tip are pulled so close together it appears as if the nose comes to a single point. The problem usually occurs when a surgeon cinches down the suture between the tip points too tightly.

To correct the problem, the points must be separated and rebuilt with cartilage to achieve the proper balance. Other Tip Problems: Wide Tip, Bulbous Tip, and Deviated Tip If too much of the supporting cartilage for the tip is removed, the resulting tip can collapse and wind up looking too wide or too bulbous. Excessive scar tissue formation after a rhinoplasty can also lead to these same two aesthetic problems. Just as with a drooping tip, the underlying support for the wide or bulbous tip must be strengthened, while scar tissue needs to be carefully reshaped with sutures. A pre-existing deviated or twisted tip can persist after a rhinoplasty or it can result from a rhinoplasty when too much cartilage is removed on one side and the nose buckles and warps. In a best case scenario, the problem can be corrected by stabilizing or resuspending the tip cartilage with sutures. However, when the problem is the result of missing or damaged underlying structures from a previous rhinoplasty, grafts of cartilage from the septum or the ear must be used to rebuild the necessary support.

Nostril Problems Collapsed Nostrils/External Valve Collapse The narrowest area in the inner structure of the nose is termed the "nasal valve." For normal, unobstructed breathing, it is essential that the entire valve area remain open. While internal nasal valve problems can occur during the removal of bumps on the bridge of the nose, external valve collapse happens when too much tip cartilage is removed during a rhinoplasty procedure. Without proper tip cartilage support, a blockage occurs in the nasal valves just above the nostrils. Addressing the problem means reconstructing tip cartilage to provide adequate support. Hanging Columella, Retracted Nostril, or Alar Retraction Failure to ensure proper tip support can lead to other nostril-related problems. The "columella" is the name of the structure that separates the two nostrils. Ideally, this area should only be a few millimeters lower than the edge of the nostrils.

If too much of the nasal spine or the bottom of the septum is removed (the structures that support the nasal tip), the columella will appear to hang down too much, called a "hanging columella," and the rim of the nostrils will retract, or pull back, excessively. Not only will the face take on an unflattering "snarl-like" appearance, but breathing can be adversely affected. Fixing the problem requires complex cartilage grafting. When too much cartilage is removed and excessive upward scarring occurs inside the nostril sidewall after surgery, patients can experience a different problem called alar retraction, where the inside nostril sidewall shows too much. The problem can be corrected with cartilage grafts in minor cases or composite grafts of cartilage and skin (usually from the ear) in severe cases. General Aesthetic Problems

Question: What is the common description of the term rhinoplasty?
Answer: Nose Job