Most cosmetic surgeons appropriately tell their patients to wait up to one or two years for the final result of a rhinoplasty. During this time, the edema caused by surgery will subside and the "final result" of the surgery is unveiled. However, when we look at the long-term follow-up, we can see continual changes — even years after patients' "final results." This phenomenon occurs in various degrees regardless of the surgeon and the technique used. However, excellent surgical skill, proper technique and dissection in the appropriate plane will tend to minimize trauma and skin shrink-wrapping around the skeletal framework.
Furthermore, proper diagnosis of the functional defect and aesthetic deformity allows surgeons to choose the least traumatic approach to the nose that will still achieve good results.Given the inevit-ability of the shrink-wrapping and the continual inward pressure on the nasal skeleton by the overlying soft tissue, facial cosmetic surgeons have changed their approach to rhinoplasty. They have always integrated the nasal airway's importance into the surgery, taking into account the need for a wide, patent, moist chamber. However, now surgeons can safely predict the effects of surgery on the nose and try to build a strong, architecturally sound structure to prevent collapse and an operated looking nose.
This new approach has resulted in less aggressive reduction rhinoplasty. In some areas of the country, namely California and New York, female patients still desire the up-turned, ski-sloped noses of the Hollywood actresses of previous generations. However, more often than not, patients want a beautiful yet natural looking nose. A nose that does not come with the signature of its plastic surgeon.
Nasal tip treatment
Our approach to the nasal tip has also changed. We tend to shy away from the "pinched" tips of the past and strive to create a more aesthetic and natural triangular base. This has resulted in much more conservative cephalic trims of the lower lateral cartilages to preserve structural integrity and more common use of strut and other cartilage grafts.
Although these changes reflect the increased utilization of the external approach to the surgery for better visualization and easier placement of structural grafts, we must remember to "do no harm."
An extensive dissection and undermining is not the best option to create minimal changes. One surgery does not fit all. Each approach and technique has its time and place in the armamentarium of the rhinoplasty surgeon.