Case Study 2:
The patient was concerned about her tip being wide and without shape and her profile being prominent. Her preoperative photo shows the width and fullness of her tip. The base view shows the wide, flat boxy square shape of the tip with strong cartilage fixing the shape. The lateral and oblique views show the dorsal profile prominence and overprojection.
I chose an open approach for this patient because I felt that it would give much better control to solving a number of challenges. I wanted to shape and narrow the strong tip cartilages without causing pinching and rotation. I thought the profile prominence gave the illusion of being big but in fact was not so and therefore a set up for over reduction. Correcting these issues required a degree of sutures, grafting and visualization, which I did not feel I could get with a closed approach.
Her postoperative photos show her frontal view with good narrowing of the boxy tip without pinching of the tip. The bridge is lowered with preservation of the middle third width of the nose. Her base view shows nice change from the square box to a pleasing triangle. The incision on the columella is not visible. The nostril rims are well supported. The lateral and oblique views show lowering of the dorsum with preservation of a strong profile height, deprojection of the tip without rotation and excess nostril show.
I believe both of these patients illustrate the concept that it is not the approach that counts but the result. Both are 3-4 years out from their surgery and show excellent integrity of their new noses. For patient 1 I was able to achieve what was needed with a closed approach. I don’t think I could have achieved the same result for patient 2 without an open approach. I don’t think a casual observer could tell the difference between the two approaches without this description.
- Michael L. Schwartz, M.D.
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- United States, FL, West Palm Beach, 1515 North Flagler Drive, #920, 33401
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