Patient with broad nose deformity with a flattened nasal tip

The patient is a 31-year-old man from Panruti in Tamil Nadu, India. He had always disliked the shape of his nose. This had led to the patient feeling very self conscious in social situations.

About two years ago, his friend had recommended a cosmetic surgeon in a nearby city. He was advised to undergo a nose job by the surgeon. The patient had undergone a rhinoplasty procedure performed by the surgeon. Both bone and cartilage play an important role in giving shape to the nose.

Costochondral rib grafts had been harvested from the patient at the time of surgery. These grafts were used to augment the patient’s flattened nasal bridge. The patient however was not satisfied with the results of the surgery. This had resulted in a slight deviation of the nose to the right.

This had caused the patient to become withdrawn and depressed. Growing concerned over this, his family had made enquiries regarding treatment centers for corrective surgery. They had subsequently been referred to our hospital for management of his broad nose deformity.

Development of nasal forms over the millennia of human evolution

Nasal shapes were classified first by Eden Warwick back in 1848. Nasal shapes are mainly influenced by racial origins. Shapes of the noses were influenced by climatic conditions that each race developed in. The shapes were thus crafted over several thousands of years of human evolution. Facial features are greatly influence by nasal shape.

The narrow aquiline Caucasian nose developed in cold climes where a narrow aquiline nose enabled warming up of inhaled air. A broader African nose developed in hot climes where the air was cooled down during its passage through the nasal cavity. This perfectly explains the development of different nasal forms in various regions around the world.

Anatomical nasal shapes and various nasal deformities

Nasal deformities can be classified broadly under broad nose deformity, crooked nose deformity and flat nose deformity. These would include saddle nose deformity, dorsal nasal hump, and parrot beak deformity. Certain birth defects such as Down’s syndrome are associated with characteristic nasal deformities. Patients have a typically small nose with a flattened nasal bridge.

Clinical examination of the nose

Dr SM Balaji, Cosmetic Rhinoplasty Surgeon, examined the patient and obtained a detailed surgical history. The patient related that the previous surgery had resulted in a deviated nasal deformity. There was also no reduction in his broad nose deformity.

He also stated that there were breathing difficulties during sleep. The patient wished to have a narrower nose with a prominent tip.

Detailed treatment planning explained to the patient

It was explained to the patient that a closed rhinoplasty would offer best results for his condition. Nasal augmentation would be performed with the use of perfectly shaped costochondral graft harvested from the patient. This would be followed by Weir excision for reducing the breadth of his nostrils. The patient and his parents were in agreement and consented to surgery.

Successful correction of the nasal deformities with good nasal form

Under general anesthesia, a right inframammary incision was made at the site of the previous surgical scar. The scar was excised and costochondral rib graft was harvested. The incision was then closed in layers with sutures.

This was followed by a transcartilagenous incision in the right nostril and dissection was done up to the nasal dorsum. The previously placed graft was removed and the nasal dorsum was augmented using the harvested rib graft.

This resulted in elevation of the nasal bridge and correction of the crooked nose deformity. A Weir excision was  performed to reduce the broad nasal base. Closure of the incisions was done through the use of resorbable sutures and non resorbable sutures.

Total patient satisfaction at the results of the surgery

The result of the surgery was immediately visible. There was perfect nasal symmetry with correction of the crooked nose. The nose was also narrower without any compromise in function. The patient and his parents expressed their gratitude before final discharge from the hospital.

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