Treatment of presistnent large nose
Many patients present for revision rhinoplasty because they feel that their noses are still quite large despite previously undergoing primary rhinoplasty. There are many reasons for these concerns the most common being that there is an imbalance between the different areas of the nose and face. In order to achieve a harmonious aesthetics of the nose, there needs to be an excellent balance between the nasal bridge and tip. Furthermore, the nasal bridge and tip need to be in balance with the chin and the rest of the profile, and from a frontal view there needs to be an aesthetic balance between the various segments of the face. We typically divide the frontal balance into the width of an eye. The width of an eye should equal the width of the nose from nostril-to-nostril, and if there is imbalance in that aspect the nose will appear enlarged from the front portion. Furthermore, the width of the bridge in the front from a frontal view needs to be roughly 75% of the width between the nostrils, and when there is imbalance between the width of the bridge and the width of the nostril, there will be an imbalance that will reflect poorly on the nose.
All of these factors need to be analyzed and Dr. Azizzadeh, the Director of the Institute for Rhinoplasty & Nasal Reconstruction (Beverly Hills, California) spends a significant amount of time in the analysis of the nose to determine why the patients feel that their noses are persistently large. Another important factor in a persistently large nose is the thickness of the skin. There are many patients who have extremely thick sebaceous skin that have not noticed any changes after the previous rhinoplasty. Furthermore, significantly enlarged cartilage especially in the tip area is often a major complaint of patients who have previously undergone primary rhinoplasty and have not achieved the desired goal. Lastly, an over-projected nose can also be a major complaint of patients who have previously undergone rhinoplasty and feel that their noses are extremely large. One of the main complaints that Dr. Azizzadeh sees in his revision rhinoplasty practice in Beverly Hills and Newport Beach, California is an over projected enlarged nose that requires creation of a harmonious balance between the bridge and tip. During the revision rhinoplasty consultation, Dr. Azizzadeh carefully analyzes the nose to find imbalances and will discuss with the patient how to address these issues in detail. Oftentimes, the patient will have an imbalance between the tip projection and the chin projection and as a result the patient will in addition to the revision rhinoplasty to re-project the nose will require chin augmentation (chin implant) to correct the balance and the profile. This procedure is also known as profileplasty, which is extremely important to aesthetically balance the facial features. Furthermore, many patients present with significant midface atrophy and hollowness that creates imbalance with the nose and midface region. As a result, the midface oftentimes requires augmentation with either multilevel fat grafting or a midface implant. Although thse are less likely circumstances, it is extremely important to identify other regions of the face that can have a tremendous impact on the appearance of the nose. For patients who have thick sebaceous skin and enlarged nose, Dr. Azizzadeh has a regimen of placing the patients on aggressive skin care treatment for a period of four weeks prior to the revision rhinoplasty. These will improve the sebaceous nature of the skin and reepithelialize the skin, thereby creating a better covering of the nose following the revision rhinoplasty. In addition, Dr. Azizzadeh at the time of the revision rhinoplasty will address the nasal skin envelope to allow better refinement of the nasal tip if necessary. Following the surgery, the patients will undergo fractional laser resurfacing to further refine the skin nature.