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A healthier approach to rhinoplasty

Article-A healthier approach to rhinoplasty

A surgeon who fails to recognize and respect the nasal valve during rhinoplasty risks worsening a patient's nasal airway. Conversely, identifying and addressing a nasal valve problem during the rhinoplasty often results in patients who are satisfied not only with their cosmetic appearance but also with their functional nasal breathing, says Oren Friedman, M.D., director of facial plastic surgery and associate professor, Department of Otorhinolaryngology, University of Pennsylvania School of Medicine, Philadelphia, Penn.

Yesterday Dr. Friedman presented, “The Nasal Valve, What is It and How do We Deal with it?” at the 11th annual Vegas Cosmetic Surgery and Aesthetic Dermatology multispecialty aesthetic symposium in Las Vegas.

“The nasal valve is the nasal area defined by the upper lateral cartilage, the nasal septum and the nasal floor. It is the narrowest part of the nasal airway, and, as such, it is the primary regulator of nasal airflow. There are many causes of nasal valve narrowing, and each may lead to nasal breathing difficulties,” he says.

Spreader grafts, alar batten grafts, nasal valve flaring sutures, butterfly grafts and correction of vertically malpositioned lower lateral cartilages are among the many techniques aimed at repairing dysfunctional nasal valves. The technique one choses depends on where the problem lies and what the nose looks like, according to Dr. Friedman.

“The key point is to recognize the importance of the nasal valve when performing rhinoplasty,” he says.

Rhinoplasty, which used to involve reducing nasal size by removing supportive nasal cartilages and bone, often resulted in not only distorted looking, but also dysfunctional, noses, Dr. Friedman points out.

“Strengthening the nose with supportive grafts and techniques during rhinoplasty aims to provide structural support that improves a patient's outcomes, not only in the immediate post-operative period, but it also aims to preserve the nasal airway and structure over the long term. While nasal obstruction due to nasal valve collapse used to be an extremely common long-term complication of rhinoplasty, we are seeing it much less frequently today,” he says. “With what we know today, it is no longer reasonable to address only the form of the nose without regard to its function.”

To learn more, see Dr. Friedman’s published study: Saleh AM, Younes A, Friedman O. Cosmetics and function: quality-of-life changes after rhinoplasty surgery. Laryngoscope. 2012 Feb;122(2):254-9. 

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