Dr. Buckingham’s Q&A

Question:
I think my nose is okay but I do think some very small improvements could be made. Is undergoing surgery for some small refinement not worth it?

Answer:
That is a question that is very individual and can only be answered with a consultation.  Some individuals’ interpretation of something "small" may be very different from others.  A correction of taking off a small hump is much easier than correcting a small asymmetry in the tip.

Posted by Dr. Buckingham

Question:
What determines whether or not the nose needs to be broken for a hump removal?

Answer:
The size of the hump or deviation of the nasal bones determines whether or not the nose needs to be broken.  If you remove a hump then you are separating the attachment of the nasal bones from each other.  ie. The more you take down, the farther apart the separation of the nasal bones.  This is referred to as an open roof deformity if not corrected with osteotomies, "breaking the nose".  In general, I have a very low tolerance for performing osteotomies as they are relatively easy to perform, do not cause any more recovery, and I prefer not to correct an open roof secondarily.  The need for osteotomies should not deter ones decision for rhinoplasty. 

Posted by Dr. Buckingham

Question:
Where are the incisions made for a typical rhinoplasty? Are they visible to others?

Answer:
Two types of rhinoplasties can be performed, endonasal (closed) and open.  In the endonasal rhinoplasty technique all of the incisions are located inside the nose.  For open rhinoplasty most of the incisions are placed inside the nose, but there is also a small irregular incision located across the bottom skin of the nose called the columella.  This incision is barely perceptible and rarely to never causes any concern.    

Posted by Dr. Buckingham

Question:
How can a rhinoplasty fix a nose that has been broken and twists to the side?

Answer:
The nose is divided into three parts, the bony dorsum, the cartilaginous dorsum and the tip.  When a nose is crooked each portion needs to be made straight individually and as a unified nose.  The bony dorsum is straightened by performing osteotomies, cuts in the bones and moving them to the midline.  The cartilaginous dorsum is made up of the nasal septum and the upper lateral cartilage.  If the septum is inherently deviated it can be excised and reconstructed.  If the upper lateral cartilage is deviated or asymmetric then it can be straightened by adding grafts either between the septum and upper lateral, called spreader grafts or by grafting cartilage on top, called an onlay graft.  The tip cartilage again is often affected by the nasal septum and creating a straight septum is the first step.  The cartilage itself is then sutured into position to create a straight symmetric nasal tip. 

Posted by Dr. Buckingham