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This right lateral view shows the lack of a nasal hump after the surgery. The classic view of idealized female Caucasian nose is supposed to have a nasal tip that is slightly higher than the rest of the nasal dorsum. This “classic” preference is certainly subjective and does not have to be the goal. Nonetheless, this was achieved in the post-operative rhinoplasty view.
This view shows the improved nasal dorsum (with reduced nasal hump). The tip of the nose was rotated slightly upward, but other than than that change the patient was happy with her tip – so no further changes were made.
As I noted previously, the patient did not desire any significant changes to her nasal tip (other than tilting it up slightly). Because of her not wanting any significant change on her nasal tip, I was able to perform the surgery with the “closed” technique, which means there were no external incisions on the nose. Please note on this view that that the shape of the tip from the basal view is basically the same, just as the patient requested. Also, note that there is no incision on the columella (the skin between the nostrils) as there has to be with an external (or “open”) rhinoplasty. I make the decision with each patient as to whether they should have their rhinoplasty performed “open” or “closed” during the consultation. As with all aspects of Rhinoplasty decision-making, each aspect of the surgery should be discussed in a detailed and unhurried way so they patient can have an good handle on what is being planned. My philosophy is not to be overly technical about every detail of the surgery with the patient, but I do think that patient’s should actively participate in the meaning decisions around their surgery, and they can only do that if they understand the essential concepts.
This is one of the very few intra-operative pictures I have included on my site! I wanted to share this picture to make a few points. Firstly, you can observe that the nose has achieved its essential post-operative appearance at the end of the surgery – the nasal hump has been removed, the tip is slightly raised, and she has a nice supra-tip break. There is a saying that Rhinoplasty surgeon’s have – “The nose should look good on the table at the end of the case.” What we mean by that is that the surgeon should not imagine that the nose will look significantly better after months of recovery. In this picture the nose looks good, and therefore the patient and surgeon can expect it to look good after the full recovery process. Furthermore, I’d like you to notice that there is not a tremendous amount of swelling or bruising. You can see that there is a modest amount of bruising on the side of the nose, but nothing to alarming. In the majority of cases bruising and swelling should be pretty manageable after a rhinoplasty.