Once your bone and cartilage have been resculpted, your surgeon pulls the skin back down and stitches it along the open-rhinoplasty incision across the columella (the tissue that links the nasal tip to the nasal base). “When done properly, that incision is extremely hard to see, once it’s healed,” says Dr. Miller. With a closed procedure, the incisions are made inside your nostrils, so there’s no visible scarring, and the sutures are usually dissolvable.
Case 47: This patient’s primary surgery left her with valve collapse, nostril notching, persistent tip rounding and hanging columella. Secondary surgery involved correction of these issues with repositioning and reconstruction of the tip cartilages to improve tip contour. Although she is still a little swollen in the after photos, she is already happy with her new nose.
The closed vs. open rhinoplasty technique concerns only how the surgeon gets inside the nose to make the required changes, not what’s accomplished with the rhinoplasty procedure itself. Reshaping your nose may include breaking and removing bone and cartilage. If cartilage needs to be added, say, to rebuild the tip of the nose, it’s often taken from the septum, the middle portion of the nose—a technique called a cartilage graft. Cartilage may also be taken from other areas of your body, such as your ear. In some cases, a synthetic material, like a silicone implant, is used; but studies have shown that there may be more complications with synthetics. Cartilage grafts, nasal-bone osteotomies (removal of parts of the bone), dorsal-hump removal, and suture techniques applied to the nasal tip cartilages can all be performed with either the closed- or open-approach rhinoplasty.
Case 46: A hump and hanging tip cause the nose to dominate otherwise beautiful features in this young woman. In this case, a tip lift, hump reduction, and tip refinement preserves some of her rounded appearance, very naturally enhancing her pretty eyes. On the bottom view, we see a good example of how open rhinoplasty incisions should heal virtually undetectably when done with care.
Case 3: A curvature and droopy tip brings undue focus to this young man’s nose. Although there is still some swelling in these early post-operative photos, we can already see a nose that is now straight, has a smooth profile and no longer droops. A sense of length is preserved to match his oval face. More than that, because of these positive changes, he also looks younger.
The statement usually encouraged positive remarks about the potential communal meaning of a mixed-race member of the royal household. Markle declared that she’d give up work from drama, and started the procedure of becoming a British resident. The personal service, conducted with water in the River Jordan, happened in the Chapel Royal in St James’s Palace.
Chances are good that you know at least one person who’s had a nose job. The American Society of Plastic Surgeons says that rhinoplasty is the third most popular cosmetic surgery, with more than 200,000 patients opting for the nose procedure every year. Whether it’s right for you depends on a number of factors, including the cosmetic and structural issues you’re looking to change, your budget, and the amount of time you can take off for recovery.
Case 33: For this young woman, the nose felt boxy and unrefined in comparison to her more defined facial features. Goals of rhinoplasty included lifting and definition of the tip along with subtle hump reduction to create a more sleek and streamlined nasal contour. Achievement of these goals creates a nose that harmonizes rather than dominating other features.