Thursday, April 9, 2020

Widening a Narrow Nose - Rhinoplasty

Hi, Dr. William Portuese, based in Seattle, Washington. I'm a facial plastic surgeon, specializing in rhinoplasty. And today, we're gonna be talking about widening a very narrow nose. First of all, if they have a hump, we have to shave the hump down. That automatically widens the nose. But if they need additional widening, we make some little, tiny cuts in the nasal bones, and we place two little cartilaginous spreader grafts in the upper lateral cartilages and up in those nasal bones, and open up the nasal bones a little bit. And they're held open with those cartilage grafts. The cartilage grafts are harvested from inside the patient's nose, so it's their own tissue. It's not a foreign body or anything. And that ends up holding the nasal bones in a more open and wider position so that the dorsal aesthetic lines look much better, rather than this pinched nose we occasionally see. The spreader grafts that we use to widen a narrow nose are only about two millimeters in width. So, when you put two spreader grafts in, you're only getting four millimeters of width to the nose. That's about a quarter of an inch. But that makes a pretty dramatic and remarkable difference between the before and the after photos. And patients, you know, it really helps that pinched nasal bone, when they're really excessively narrow. At one week after the surgery, the cast is removed. Patients can see their new bridge line, but the tip of the nose is typically very swollen. And so, the tip, itself, takes a long time for the swelling to subside. But, typically, visible bruising and swelling is two weeks. About 70% of the swelling has subsided at a month after the procedure, and about 90% has subsided about three months after the rhinoplasty procedure, and then, full healing takes a year. This is a patient that I accomplished, not only shaving down the dorsal hump, but he had a very narrow, both nasal bones were very narrow, and I ended up widening them a little bit. And I did that by the combination of hump removal, which leaves you a little bit more wider base. And then, I placed spreader grafts between the septum, nasal septum, and each nasal bone. And that widened the bridge line a little bit, along with reverse osteotomies, which are cuts in the nasal bones. And the spreader grafts hold those nasal bones in a wider and more open position, and that way he didn't have that pinched appearance to his nose. In the after photos, all the components of his nose are more balanced, and his nose, just, the tip of his nose doesn't look quite so bulbous, because the rest of the nose has been widened to match his tip. The spreader grafts, actually, probably improved breathing a little bit too, because the nose is so pinched. And we do perform those for some patients for functional breathing purposes.

Dr William Portuese
1101 Madison St #1280
Seattle, WA, 98104 USA
206-624-6200
https://www.seattlefacial.com
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