Aesthetic Reconstructive Rhinoplasty

Abstract

During the past decade, a new sophisticated level of nasal surgery has emerged – aesthetic reconstructive rhinoplasty. It has its origins from two sources. The first is the incredible aesthetic results achieved in nasal reconstruction by Burget (1994) and Menick (1999). These advances are to nasal reconstruction what Tessier’s contribution was to facial reconstruction. The second is the dramatic improvement in the results of secondary rhinoplasty beginning with the balanced approach of Sheen and then followed by the correction of the nasal foundation using the open approach. The critical factors are the insertion of structure and the goal of achieving true aesthetic natural results rather than mere “improvement.” However, these advances have not come without an equally dramatic increase in requisite surgical skills including the use of rib grafts. One only has to think of the three Cs — clefts, cocaine, and catastrophes to realize the difficulty of both the problems and the corrections. In many cases, the solution will be the new concept of “composite reconstruction” in which a deep structural foundation layer is inserted first and then overlaid with an aesthetic contour layer (Daniel 2007). The advantage of this technique is that one can maximize the reward while minimizing the risk. For the experienced surgeon seeking the greatest challenges in rhinoplasty surgery, these cases represent an extension of techniques perfected in secondary rhinoplasty rather than a completely new operation with a prolonged learning curve. Yet a word of caution is necessary. These are neither hopeless cases nor can a beginning surgeon justify doing them because the expected improvement is minimal. These patients have suffered a great deal in their lives and deserve the best possible result.