Rhinoplasty and Revision Rhinoplasty

“I have been concentrating on the nuances of primary and revision rhinoplasty for my entire career. Rhinoplasty is a very difficult operation; many surgeons would agree that it is the most difficult of all cosmetic surgery procedures for various reasons. There are many factors that must be taken into account when planning and doing a nose. I find computer imaging to be useful in determining what the goals of the patient are and how they mesh with what I would recommend and what is possible to achieve surgically. Getting a nose just right means the surgeon must take into account many subtle details of the patient’s anatomy including cartilage size and thickness, skin type, relationship of the bridge to the tip to the alar rims. The surgeon must have full knowledge of the ramifications of each maneuver on other areas of the nose. For example, I have revised many noses where I found at surgery that the lateral cartilages that extend from the tip out along the ‘alar’ rims have been either removed or sutured together upward along the bridge of the nose. In each case, this caused the rims to be drawn upward causing a very unpleasing result.

“I presented a talk in January, 2009 at the 25th anniversary meeting of the American Academy of Cosmetic Surgery entitled: Revision Rhinoplasty: Addressing the Alar Rim/Tip/Columellar Complex. I am currently preparing a paper with examples of cases I have revised, some of which can be seen under “Revision Rhinoplasty” at drmichaelschwartz.com.

“I prefer strong noses to overdone noses, and I believe keeping the hump reduction in a more vertical rather than oblique plane maintains strength of the dorsum without giving a ‘ski-slope’ appearance. Likewise, I want the tip and alar rims to be in harmony, and for the tip to be refined but natural in appearance. I take every precaution to achieve the goals of each patient without creating a “done” or “operated” look.”

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