Rhinoplasty of the Nasal Tip - Open Vs Closed Approach

By far, the most challenging aspect of rhinoplasty surgery is in the nasal tip. As the nasal tip is probably the greatest variable in appearance amongst individuals and one of the most defining parts of the nose, precision in nasal tip changes during rhinoplasty is of critical importance. Therefore, good access to provide adequate visualization and workability of the nasal tip cartilages is key.

Rhinoplasty, by its history, has been traditionally done through a closed or endonasal delivery technique. By this approach, the nasal tip cartilages are delivered without using a skin incision at the columella. In the 'right' nose, I personally prefer this technique as it is simple, produces consistent results, and has a low rate of the need for revisional surgery. It also offers the bonus of less prolonged swelling of the nasal tip after rhinoplasty. Good patients are those that have fairly thin nasal skin, strong stiffer cartilages, and have never had rhinoplasty surgery before. The only problem with the closed approach to rhinoplasty is that it requires more finesse in delivering and suturing the cartilages than an open approach.

Open structure rhinoplasty, where the entire nasal tip is widely exposed, is done by making a incision across the columella (skin between the nostrils) and lifting the skin off of the nasal tip. With such exposure, manipulation of the nasal tip cartilages is much easier and symmetry between the sides better appreciated. For this reason, open rhinoplasty is the most common way rhinoplasty surgery is done today and, in most surgeon's hands, produces more reliable results. It certainly is the way to go in revisional rhinoplasty (of the tip area) and in primary rhinoplasty where the patient has thick skin, nasal tip asymmetries, or weak cartilages. The fear over a columellar scar is largely unfounded as they heal nearly imperceptably. The biggest problem with gloving the nasal skin through an open approach is that some patients will have some prolonged swelling of the nasal tip, particularly those with really thick skin.

The debate between open vs. closed rhinoplasty isn't really a debate anymore. It is more about what type of nose does a patient have and the plastic surgeon's experience with each rhinoplasty technique. When considering rhinoplasty (nose reshaping) surgery, talk to your plastic surgeon in depth about your goals and how he or she is going to meet them. Ask if your rhinoplasty surgery will be done open or closed... it shows you have done your homework.

Dr Barry Eppley is a board-certified plastic surgeon in private practice in Indianapolis, Indiana at Clarian Health Systems. (http://www.eppleyplasticsurgery.com) He writes a daily blog on plastic surgery, spa therapies, and medical skin care at http://www.exploreplasticsurgery.com

Lip Augmentation Surgery

Like many cosmetic plastic surgery procedures, the movie industry has put lip augmentation on the map. Angelina Jolie is the celebrity most commonly associated with enhanced lips, although she seems to have come by hers naturally. Nevertheless, soft tissue fillers of several varieties have been developed and are now used by cosmetic plastic surgeons for lip augmentation. An experienced cosmetic surgeon, however, will point out that different fillers serve different purposes.

It is also important to point out that while Angelina Jolie may be the model choice for millions of women, the age group that seeks out lip augmentation is thirty five years and up. For women in that age bracket, often the lip augmentation procedure(s) they are seeking is restoration of their younger look rather that an increase in prominence for their lips. Patients seeking lip augmentation are really looking to get rid of the lines around their mouth or the lipstick lines on the lip edges.

Some fillers are more permanent than others. The most popular, Botox, has a life of several months. Cosmetic plastic surgeons also make the point that some fillers are more appropriate for certain areas than others. Semi-permanent fillers may be a good idea for areas around the lips and for the lipstick lines but not a good decision for the inner lip, where they may develop visible clumping.

Hyaluronic acid fillers are recommended by many cosmetic plastic surgeons as the safest choice for the inner lip. They generally have a life of three to six months, so repetition becomes part of the choice. Collagen is a more permanent selection, but is much more costly than hyaluronic acid. Brand names for these products include Restalayne and Juvederm.

Cosmetic plastic surgeons have also developed a technique of fat transfer that can be used in the process of lip augmentation. Excess fat cells from elsewhere in the body are extracted with liposuction and transplanted into the lip. Other permanent inserts include gel-like products that are either made from human cells or mimic them.

All of these choices are eventually going to deteriorate in from three to five years. There is an insert manufactured from Gore-Tex that is truly permanent, but it is also a foreign object that can be rejected or, over time, emerge as an unsightly bump. Lip augmentation is a developing technology; finding a lasting tissue for a highly sensitive soft tissue area such as the mouth continues to be a challenge.

Mary Hart is a freelance writer specializing in Cosmetic & Beauty topics. DrBrianHoward.com has been helping his patients realize their Atlanta plastic surgeon goals at his Roswell-area facility since 1998. Find information about all types of plastic surgery procedures including lip augmentation, breast implants, breast augmentation, face lifts, and liposuction.