Management of bone in rhinoplasty includes bony hump resection, septal bone correction, and deviated nasal bone osteotomies. All these can be done efficiently with ultrasonic instrument. Advantages of ultrasoninc instrument over conventional method are less bleeding, less swelling, and greater control of fine bone adjustment. Patient can benefit a lot from this instrument, while doctors are more confient in bone managing techniques. I delcalre that I have no financial interest with the manufacturing company.
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.
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