Orlando, Fla.—Reshaping the nasal tip is perhaps the most difficult part of rhinoplasty, particularly in certain types of broad-nose deformities.
Dr. Erol, who also serves as chief of the plastic and reconstructive surgery department of American Hospital in Istanbul, notes that among the 3,800 rhinoplasties he's performed in the past 14 years, 2,200 involved tip rhinoplasty for broad noses. He says the new technique uses a vestibular approach during rhinoplasty.How it's done
"After the dorsal, lateral and septal work is completed, defatting of the tip region is performed," Dr. Erol says.
"Through a 4 mm longitudinal incision on the lateral side of the columella, a pocket is created inside of the crura, from the base to the tip, using blunt-tip scissors. In select cases, such as those with a short columella and flaring nostril, the alar base is approximated using subcuticular Ethilon sutures," he explains.
Then, he says, harvested cartilage is diced in 0.5 mm pieces. This is most effectively accomplished with the use of a number 11 blade wrapped with Surgicel (Ethicon) molded into cylindrical form, inserted into the columella and pushed up to the tip region.
"When this is accomplished, a strut of cartilage is inserted into the columella below the diced cartilage mass," he says. "After the mucosal stitches are complete, the tip is externally molded between the fingers so as to achieve the desired form."
According to Dr. Erol, shaping the tip region with diced cartilage and approximation of the alar base significantly improves results in these difficult broad-nose corrective procedures.
"Using this surgical technique consistently results in giving these broad-nose deformities a desirable new form," Dr. Erol says. "In addition, the technique eliminates the complications of late show of the strut."
Dr. Erol concludes by noting that in broad-tipped noses that have thick skin and weak cartilage, defatting, remodeling of the tip and use of cartilage graft as a support is necessary in order to obtain satisfactory results.