Technical Aspects of Rhinoplasty

Open vs. Close Rhinoplasty:

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We perform both. The difference is the small incision in the columella (area between your nostrils) outside of your nose in the open approach. The scar is virtually imperceptible in almost all patients. In the close approach, the incision is inside your nose, with no external incision. The open approach can give the surgeon greater control of certain part of the nose. The decision to choose either approach will depend on your anatomy, our discussion of your goals and intraoperative findings.

 

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Septoplasty:

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Septoplasty is primarily a functional surgery to improve your airflow. This can be insurance covered under certain circumstances. Usually Dr. Boonipat will straighten your nasal structure, while keeping most structures intact. Usually this will also improves how your nose look.

 

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What is Preservation Rhinoplasty?

 

This is a relatively new development in rhinoplasty that allows long lasting result, minimize unexpected issues, and minimizes recovery time.

-It is suitable in a particular population of patient. We will discuss with you whether this is appropriate in your situation after full physical exam.

-It is a fundamental shift in rhinoplasty concepts from reducing and rebuilding to preserving and reshaping the internal structure of the nose.

-The skin elevation and surgical plane is in the subperichondrial-subperiosteal plane. This reduces the swelling postoperatively. It also reduces long term chances of thinning of the skin.

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-The bridge of the nose and the connection between the cartilages are maintained. This reduces the chance of long-term deviations, irregularities, and breathing issues.

-The tip cartilages (called the lower lateral cartilages) are maintained with minimal excision. This prevents long term alar retraction and other unpredictable deformities. We achieve the desired shape with suturing. Onlay grafts are minimizes as they can lead to long term unpredictable results.

-We use septal extension grafts and tongue in groove procedures to maintain a stable position of the tip.

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-We preserve as much as possible the ligament connections between the cartilages and the cartilages and bone. This again improves the long-term predictability of the result.

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- In certain case, an alar reduction (Weir excision) is used to reduce the width of your nose.

 

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-In the Asian or some ethnic population where primarily an augmentation approach is needed, a hybrid method is utilized. We preserve what can be preserve, while augmenting the native structures with frozen cartilages or your own cartilages (rib or ear cartilages).

-We also utilizes a new innovation in dorsal augmentation while avoiding the diced cartilage method, which can lead to irregularities and a -sausage like augmented nasal dorsum.

-This gives you a well-defined, long-lasting result, with improvement to your breathing.

 

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What is Piezosurgery?

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Piezosurgery is a new ultrasonic energy vibration device use to cut bone without damaging soft tissue. In the traditional method, surgeons use hammer and sharp chisels to break and modify bone. This is done usually in a blind manner without the surgeon seeing exactly where the cut is. This led to a lot of collateral damage to the soft tissue and unexpected bone breaks, causing prolonged swelling. With the piezosurgery device, we can precisely sculpt your bone instead, leading to less bruising and less swelling. There is good research that Piezosurgery shortens recovery time. The precision also allows for accurate and consistent creation of the dorsal aesthetic line, the nice shape of the nose on frontal view.​

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​​​​​​​​​Dr. Boonipat is experienced in these new rhinoplasty technique, and he have significant clinic exposure and background in ethnic rhinoplasty.