LPSA

Leading Plastic Surgeon Highlights Alternative Technique Resulting in Less Downtime, Bruising

London – 15 August, 2006 – Expert consultant plastic surgeon Martin Kelly, a co-founder of London Plastic Surgery Associates (www.lpsa.co.uk), a leading cosmetic surgery clinic dedicated to providing comprehensive care in the field of plastic surgery, today addressed a type of Rhinoplasty – or 'nose job'- where bones don't need to be broken and which offers less downtime, swelling and bruising for the patient.

According to Martin Kelly, a craniofacial expert and member of the British Association of Aesthetic Plastic Surgeons (BAAPS);
“Surgical refinement of the nose almost always involves reshaping the nasal tip. In some cases, the tip is the only part of the nose that requires attention. This is often referred to as a 'tip rhinoplasty'. Because the nasal bones do not need to be fractured in these cases, the swelling and bruising that usually follow surgery are significantly reduced, and the patient is back at work and normal lifestyle much sooner than usual.”

The nose's tip reflects ambient light and is difficult to conceal. Unlike the dorsum (nasal hump) which reveals its curves in profile, the bulbous nasal tip often looks worst when viewed from the front. It is made up essentially by a pair of cartilages (the 'alar' cartilages).

According to Martin Kelly;
“You can test the volume and resilience of your own alar cartilages, by gently pinching the tip of your nose between thumb and index finger, where the tip is at its widest. As you compress the bulbous part, you will feel a spring-like resistance in your fingertips. These are the alar cartilages. They are the structures primarily operated upon during tip rhinoplasty”

Thickness of the skin is also a critical factor in deciding how refined the nasal tip will appear after surgery. While cartilages can be trimmed, sutured together, bolstered by grafts or even replaced, skin cannot. Looking in profile, the distance measured between nasal tip and where the nose starts from the face is called tip projection. Changing tip projection can dramatically alter the beauty of the nose.

A nose that is underprojected (whilst looking in a mirror, gently press the tip of your nose towards your face) loses its beauty and character, and can resemble caricatures of witches or mean spirits. An overprojected tip can look sharp or overassertive.

Martin Kelly says;
“The demand for absolute surgical accuracy in rhinoplasty means that revisions are more commonly required with the tip than any other part of the nose. A frequent area of concern is where the tip joins the bridge of the nose. This area is known as the supratip, where post-surgical swelling is somewhat unpredictable. Fullness in this area can turn a spectacular result into a rather boring looking nose.”

In thin skinned patients, the edges of cartilages may become visible in certain light or in cold weather. In thick skinned patients, the nasal tip may never be fine.

Martin Kelly adds;
“Focusing a rhinoplasty onto the tip of the nose does not necessarily make the surgery any simpler or a recommended procedure for everyone. It remains a very delicate, balanced operation, and it is wise to discuss what your expectations are in great detail with a reputable surgeon, who should then be able to guide you towards a satisfying result.”

Martin Kelly's notes on before-and-after photography of his two case studies:-

• Alisha 25, from Notting Hill, London is a patient with very thin skin at the nasal tip, naturally overprojecting. Alar cartilages were reshaped with very fine sutures. This had the effect of moving the tip backwards, and shifting the focus of attention in her face from a very sharp tip to the rest of her very pleasing profile.
  
  
  
  Before

  
  After
  
  
• Elena 32, from Ealing provides an example of the opposite problem. Her skin is thicker, and it is a fullness of the nasal hump that dominates the profile. Tip is underprojected, poorly defined. Final result shows that the tip now distances itself from the line of the bridge of the nose, which feminises and refines it.
  
  
  
  Before

  
  After