Reconstructive Rhinoplasty: What is a Nose Job?

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 Guest: Dr. Judith M. Skoner - Otolaryngology - Head and Neck Surgery (ENT)

Host: Dr. Linda Austin – Psychiatrist

Announcer: Welcome to an MUSC Health Podcast.

Dr. Linda Austin: I am Dr. Linda Austin. I am interviewing Dr. Judith Skoner, who is Assistant?Professor of Otolaryngology, Ear, Nose, and Throat here at MUSC. Dr.’skoner, I know one of your areas of interest is reconstructive rhinoplasty, what is rhinoplasty?

Dr. Judith M. Skoner: Rhinoplasty is the technical term for what other people refer to as a nose job, but really what it is, is restructuring and rebuilding the nose and that can be for aesthetic purposes and for functional purposes, and oftentimes those two things are intimately intertwined.

Dr. Linda Austin: When you say functional purposes, what do you mean by that?

Dr. Judith M. Skoner: The nose is obviously what we use for breathing and if you don’t have any problems, you don’t really think of it too much, you don’t even notice your breathing or how your nose is doing, but when you have problems with that, it becomes almost obsession or a primary focus because if your nose is obstructed, you have to breath through your mouth and it interferes with sleeping and even sometimes people will say when they are talking a lot, you know, they just really can’t tolerate that their nose is obstructed. So, once we evaluate the nose and try to figure out what it is that’s causing the obstruction, sometimes that comes down to just the structure of the outside and kind of the cartilages that holdup the nose rather than anything actually blocking the inside such as polyps or sinus disease or something again is certain more inside the nose.

Dr. Linda Austin: You know, even though we use phrases like as plane as the nose on your face. The anatomy of the inside of the nose is something that most of is never get to really see. I would imagine that just seeing what you are doing must be a real challenge in the surgery that you are doing, how do you do that?

Dr. Judith M. Skoner: There are two sorts of approaches. There is the closed approach and the open approach. The nose is primarily made of cartilage and that’s why you can push on it and move it around a little bit and there is some bone that’s creates the dorsum or the upper part of the nose, but the lower part of the nose again is really all just cartilage and once those cartilages kind of weaken, then again that’s we can end up with problems that -- it’s almost like an A-frame house kind of collapsing in, so when the cartilages get weak, it collapses in. So, what we have to do then to visualize what we are doing is you get on top of those cartilages and under the skin. So in the closed approach, you can go inside the nostrils, make some incisions on the inside of the nose, and then look through small areas to see those cartilage and bony structures underneath. You can even pull out some of those cartilages through these very tiny incisions made inside of the nose. The other approach is the open approach and frequently that’s what we have to use for more of the complicated reconstructions because as you might imagine working through these tiny little incisions inside the nose, trying to rebuild the structure of the nose is difficult. So in that open approach, we make just a small incision that’s probably 5 mm across the very base of the nose and then the other incisions are all inside of the nose and we can actually then lift up the skin of the nose, so that we can see all of the cartilaginous and bony structures and soft tissue that really comprise the structure of the nose and then if we need to strengthen those structures or widen areas that are obstructed, then we take cartilage either from the septum, which is there in the nose and so we are right there so we can borrow a cartilage from there or we can take it from the ear or sometimes we take it from the rib and then we use that cartilage to again kind of structure the nose in a fashion so that it will be more functional or more open for breathing, but then also keeping in mind what it’s going to look like for the patient, which is, you know, our second goal. So, when we do reconstructive rhinoplasties, we are trying to improve function, but also trying to keep the nose in a very aesthetic sense as to what the patient finds to be beautiful for them.

Dr. Linda Austin: That sounds really challenging.

Dr. Judith M. Skoner: It can certainly be challenging, especially when you are dealing with noses that have already had prior surgery, which sometimes is actually the cause of the obstruction whether it be again from sometimes cancer resections or even prior rhinoplasties. You can get over the years some collapse of structures. So, those are the revisions and the revisions are always more challenging, but it’s a fascinating structure and the nose continues to sort of grow and evolve over our lifetime. So, it’s definitely a challenge, but the results in the patients tend to be very happy with the results because they can breathe and look good at the same time.

Dr. Linda Austin: Dr. Skoner, thank you so much.

Dr. Judith M. Skoner: Thank you.

Announcer: If you have any questions about the services or programs offered at the Medical University of South Carolina or if you would like to schedule an appointment with one of our physicians, please call MUSC Health Connection at (843) 792-1414.


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