How clean is the rhinoplasty field?

People may think rhinoplasty is a clean surgery like heart surgery. But actually it is not.
Rhinoplasty is a clean contaminated surgery. This means there are bacteria found in the surgicla field. It also means there is a chance of surgical field infection.

In many cases, rhinoplasty is combined with septoplasty. Sepum is centered in the nasal cavity, where many normal bacterial flora exist. Thus, rhionplasty filed is always exposed to danger of bacterial infection from the nasal cavity. Even in surgeries without touching the septum, chance of infection from the nasal cavity and surrounding facial skin is high.

I did a prospective study about the effect of chlorhexidine pretreatment on the rhinoplasty surgical filed contamination. What I found is rhinoplasty filed is not sterile (even with strict aseptic technique), is continuosly exposed to contamination from the skin flora, and chance of infection has a tendency to decrease with chlorhexidine pretreatment.

This study results implicate the following.
1. Rhinoplasty is not a complete sterile field.
2. Chance of infection does always exist, so every effort should be done to decrease the chance. This includes not using alloplast material.
3. Thorough surgical filed irrigation with chlorhexidine pretreatment may help to decrease the infection.

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Deviated & hump nose correction

This lady in below photos had nasal deviation, hump nose, and tip ptosis with breathing difficulty. Septum was corrected first, and this made the lower 2/3 of the nose straight. Hump was not resected but rasped with Piezotome and this did not breach the keystone area, which made spreader grafts unnecessary.Bilateral osteotomies with Piezotome made her bone straight. Together with septum correction and effective osteotomies, her nose became straight from the frontal view. Tip was modified with sutures and onlay graft only. No strut or septal extension graft was used and this made the tip soft even after considerable amount of rotation and projection increase. Radix was augmented with bruised cartilage. Overall, she could breath much better after surgery and her nose became more harmonious and feminine.

Creating more feminine nose

The lady in below photos visited my clinic for rhinoplasty. She wanted to have more feminine nose instead of her muscline nose. She had a long nose with slight bump on the dorsum, overprojected, slightly bulbous and droopy tip, and slighly wide dorsum. Surgery was focused on creating more feminine look: hump removal, narrowing the bony dorsum with osteotomies, tip volume reduction, decreasing tip projection, and slight cephalic rotation. Photos taken 2 weeks after surgery (because she returnd back to her country after surgery) shows changes on the dorsum and the tip. Dorsum became slender with creation of smooth brow-tip aesthetic line. Tip was refined with volume reduction, slight underprojection, and cephalic rotation. Although the changes are not radical, her nose looks more feminine.

Rib cartilage rhinoplasty

Using rib cartilage in rhinoplasty needs lots of attention both in patient's and surgeon's perspective. For patient, it means additional incision on the chest, possible harvest site complications including chest pain, scar, and penumothorax, more cost, longer surgery time, and possibility of warping. From the surgone's perspective, rib cartilage is usually the last resort of autogenous material for rhinoplasty. It affords a lot of possibilities for rhinoplasty such as dorsal augmentation, tip grafts, and lots of septal grafts, all of which are not possible with other autogenous sources. It also means a lot of experience is necessary for skillful use of rib cartilage. I have used rib cartilage for rhinoplasty for more than 15 years. As cases accumulate, I can harvest the rib with small incision (less than 1.5 cm) without any complications such as peumothorax or severe pain. I do not cut the muscle and only retract it and this helps to reduce pain. Scar can be minimi...

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