Rhinoseptoplasty is probably the most complicated operation in aesthetic surgery , which requires a long learning curve and considerable dedication. Over the last few years there have been undoubtable changes of major impact in rhinoplasty techniques. This has led to an operation which is more complex, more lengthy, but undoubtedly offers highly rewarding results.
The day started with Detailed lectures on Open Rhinoplasty :
Contemporary Surgery of the Nasal Dorsum and Nasal Tip, followed by Step-by-Step dissection on Human Cadavers.
Pre operative detailed analysis of the Patient , patient concerns and Surgical options.
Examintaion of the Nose- External and Internal – How to make a Surgical Plan for a patient. Every case of Rhinoplasty being different. It is extremely important to understand the patient concerns, what can be achieved by the operating surgeon and having a balance between the two.
All the Residents could understand Basics first and many senior plastic surgeons could upgrade their existing knowledge to improvise or enhance their surgical skills.
Steps of Basic Rhinoplasty Open approach demonstrated on the cadavers included the following :
1) Involving an Inverted V incision made in the narrowest portion of the columella, which continues into the underside of the domes and is extended to the marginal incisions.
2) Proper flap elevation off the nose, dorsal and middle 1/3rdComponent separation, Key stone treatment.
3) Humpectomy and Length alteration.
4) Septoplasty and Straighteining.
5) Middle 1/3rd Reconstruction: Spreader flaps/ Spreader grafts/ Returning the ULC to the dorsal septum with sutures.
9) Use of Tip Grafts : use of shield grafts/ dome grafts/ use of fascia to camouflage tip work.
10) Osteomtomies: Traditional Medial Oblique and Low to low Lateral Osteotomies shown. In addtition the use of Piezo power toold for osteotomies also shown.
11) Correct use of Rim grafts and their placement.
12) Alar Base reduction technique.
All of the above steps were demonstrated on the cadaver. While Dr Enrico demonstrated on the cadavers, other Faculty members mentored the delegates on the other cadaver stations.
The day ended with Lectures on Closed Rhinoplasty Approach – for beginners to understand the incisions, approach, indications for closed and open Rhinoplasty.
Anatomical Videos were shown by Faculty demonstrating use of Ultrasonic Power tools in Rhinoplasty and simple approaches for patients not wanting Open approach.
The key to Rhinoplasty – is understanding that every manouvre one makes under the skin flap of the nose , produces a different result on the outisde. These results highly depend also on the patient’s Skin Quality ( Thick/Thin skin), Skin Texture and Ethnic Differences.
Even the best rhinoplasty symposia and courses worldwide have the inevitable drawback of a large faculty with different point of views which have to be expressed in a limited time. Though this allows intensive teaching in multiple formats, excess of compressed information may lead attendees to some confusion and a desire for further guided learning, in depth and unhurried.