Primary Open Structure Rhinoplasty

Primum non nocere

The first goal during rhinoplasty, as with all other aspects of medicine and surgery, is to do no harm, and it pertains to both nasal function and aesthetics. Moreover, every rhinoplasty patient will present with a set of positive nasal functional or aesthetic features that need be preserved. Capitalizing on years of training and cumulative experience while paying close attention to the patient's stated concerns, surgeons should prioritize the nasal features to be surgically addressed and, in some ways even more important, those that need to be preserved both functionally and aesthetically.

Paradigms of beauty are somewhat subjective and variable, and may shift gradually with time. Some models considered beautiful today may have not been considered as such in different time periods throughout history. However, timeless concepts such as balance, symmetry, and general guidelines of facial and nasal proportions can help lead us with the certainty and conviction of knowing the surgical goal will be aesthetically pleasing and natural-appearing decades after accomplished.

An ideal surgical result is based on excellent nasal function as well as a proportioned, balanced, natural-appearing, aesthetically pleasing nose. Conceptually, a great rhinoplasty result deemphasizes the nose to allow the casual observer to look past it, focusing on the subject's eyes, appreciating the entire face in context, without specific distractions. Each rhinoplasty is different, in as much as a person's nose should befit their gender, ethnicity, and surrounding facial features as well as their underlying facial skeletal structure.

The rhinoplasty surgeon's mindset should be to carry out every measure possible to ensure that the current rhinoplasty procedure is the patient's last one. Having said that, some patients seek and subsequently undergo revision rhinoplasty. Surgeons should strive for a revision rate that approximates zero but should be able to tolerate one approximating 5%.

Preoperative Evaluation and Diagnosis

A separate chapter is specifically dedicated to this critically important topic. Throughout the initial consultation, a complete medical history and head and neck physical examination is carried out, with particular attention being directed to the nasal anatomy and function. The patient's stated functional and aesthetic concerns are documented in the medical record and standardized digital photodocumentation takes place. An open conversation clarifying realistic expectations of what can be accomplished with rhinoplasty is carried out in light of the functional and aesthetic priorities discussed by both patient and surgeon.

The columellar scar is next to imperceptible if meticulous suturing techniques are used, and by itself it should not be a critical factor in deciding whether an endonasal or an external approach is carried out.