Minimally Invasive Rhinoplasty In Berlin

The nose, being a prominent and aesthetic figure in the profile of the face is a three-dimensional and intricate solid trapezoid. The nose encompasses the ‘outer’ body in a mesh of skin and internal cavities. While performing the functions of smell and balance, its topographical features contribute to form. A beautiful nose in a central location on the face comes with a price. But this is only when you give up on what nature has bestowed on you. Or you had a nasty accident that warrants a surgical procedure on your nose. However, whether you yearn for a slimmer nose or a bigger nose, the narrowing of the nasal tip is an attractive subject in the surgery called ‘rhinoplasty’.

THE CONCEPT OF RHINOPLASTY

Rhinoplasty is a “nose job” or “nose reshaping” which enhances the harmony of the face as well as the proportions of the nose. Often times, it has been referred to as ‘nose augmentation’ by many people. Asides its definitive terms, it can serve to correct impaired breathing that results from defects in the structure of the nose.

Basically, surgical rhinoplasty treats:

1. The asymmetry of the nose.

2. Size of the nose as it affects facial balance.

3. Width of the nose at the bridge.

4. Large, wide or upturned nostrils and

5. Enlarged, drooping or hooked nasal tip.

Furthermore, nasal aesthetics vary from one race or region to another. This is why nose augmentation is more consistent with Asians than other races due to the fact that the dorsum of their nose is lower than that of other races.
By viewing the structure of the nose, the face is divided into three – the first by horizontal lines drawn from the hair line, the glabella, subnasale and menton. However, the nose represents one-third of the face as well as one-fifth of the width of the face. Laterally, the key parameters of the nose are the nasal length, rotation of the tip, projection of the tip, and dorsal contour. But tip rotation is measured by the nasolabial angle which differs in both genders.

Sushruta Samhita successfully corrected a nasal deformity in 600 BC in India. After this historical feat, the techniques involved in nasal

TERMINOLOGIES IN MINIMAL INVASIVE RHINOPLASTY

1. Glabella — this is the smooth and slightly depressed area on the frontal bone. It is between the superciliary arches. Nevertheless, ‘nasion’ is the intersection that is found between the nasofrontal and the internasal suture.

2. Tip — this is the midpoint found at the level of the dome-projecting points. These points are found in the lower lateral cartilages.

3. Nasal root or radix — this is a point on the midline dorsum of the nose.

Anatomically, the nasofrontal angle of the nose is between 1150 and 1300 and nasolabial angle is 900 to 1100. Generally, the nasal region and the soft tissues comprise the skin, thin fat, deep fat, the perichondrium and the periosteum. However, the dermal filler injections employed in this method targets the deep fat layer to allow for shrinking. This helps to avoid vascular passage.

Targeted at the muscles are botulinum toxin injections which are injected into the muscles to adjust the horizontal wrinkles of the glabella. Whilst adjusting the size of the alar, the injections also life the tip of the nose (nasal tip). Threads can be used to reduce the widening of the dermal filler which has been injected. It performs this function through the methods of thread-induced fibrosis and contraction. However, the thread is also useful and helpful when it becomes difficult to sharpen the nasal tip with the dermal filler.

MINIMALLY INVASIVE RHINOPLASTY. SAFE ROUTE?

This endonasal form of rhinoplastic surgery involves making an external incision through the columella of the nose, thereby lifting the surrounding skin and muscle layer so that access can be gained into the bony and cartilaginous structure of the nose. Although, this can be done on selected noses but it requires surgical expertise and experience to successfully achieve the end result. Little wonder this type is fast becoming a popular plastic surgery in Berlin to give better nose appearance.

Minimally invasive rhinoplasty in berlin

Contrary to other types of rhinoplasty, minimally invasive rhinoplasty is a ‘closed’ rhinoplasty which shortens the duration of healing and bruising and leaves minimal to no evidence that a rhinoplasty was performed. Invariably, this gives some form of natural result post-surgery. By virtue of this, it is a difficult procedure. As all incisions are made internally, there appears to be zero evidence on the outside, a scar or a discolouration. Indications include rhinosculpturing, correction of contour defects after rhinoplasty, treatment of the ageing nose, and ameliorating selected nasal impairments.

INJECTION TECHNIQUE

Radiesse can be injected into dorsum of the nose to correct humps or augment the nose bridge. This can be done by using a linear threading, fanning or a cross-hatching technique.

Radiesse is a semi-solid, cohesive, biodegradable, and deep subdermal implant. It contains CaHA, the principal mineral constituent of bones and the teeth. However, when injected, CaHA is absolutely biocompatible, non-toxic, non-irritating, and non-antigenic. The injection of CaHA provides framework for the growth of collagen and prolongs the duration of the effect.

The method adopted depends on the area under treatment. By placing a needle at an angle of 450 to the skin, a subcutaneous track is created. About 0.5 ml is deposited on the bridge of the nose depending on the level of augmentation or botox to be achieved. In the nasal root, radiesse is deposited in the supraperiostal plane using the linear threading technique. This increases the nasofrontal angle.

However, in the nasal dorsum careful inspection of the reflex of the light from an upright position reveal irregularities in the dorsal contour. Because of the sensitivity of the nasal tip, the injection point should be properly thought through. By starting from the midsection and cadually to the tip-defining points, a larger surface area can be achieved by a single needle puncture. But then, injection while the needle is withdrawn effectively corrects a bifid tip while enhancing tip projection.
In sculpturing the nasal tip, it influences the refinement, inclination, length and width of the nose. But by changing the nasal tip contour, both the apparent nasal length and the dorsal height will be altered.
INDICATIONS FOR REFINEMENT OF
NASAL TIP
METHOD
Nasal tip volume reduction
Surgical
Interdomal distance reduction
Surgical
Cranial rotation
Surgical
Increasing tip projection
Non-surgical / Surgical
Decreasing tip projection
Surgical
By implication, radiesses rhinosculpturing is an easy procedure that spares operation and provides increased patient satisfaction. Although much can be achieved by minimally invasive rhinoplasty, One must be conscious of the fact that when selecting alternatives to address some deformities, proper patient selection, detailed systematic analysis of the anatomical variables, artistic perception and precise execution are of imperative.

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