Do you ever wonder how a facial plastic surgeon analyzes the nose during a rhinoplasty consultation? In this blog, we want to discuss how Charlotte, NC facial plastic surgeon Dr. Kulbersh systematically reviews the nose. He takes these observations and combines them with the wants and desires of the patient to come up with a rhinoplasty plan.
Initially, Dr. Kulbersh looks at a few general features of the nose during a consultation. They include:
- Quality of skin
- Thickness of the skin
- Obvious deformities of the nose
Proper analysis of the skin is of utmost importance as it will change the surgical plan. Thin skin on the nose can create a nose that looks sharp or pointy. Additionally, thin skin unveils every detail of the underlying cartilage and bone. This may allow minor irregularities to become visual. For these reasons, Dr. Kulbersh may elect to thicken the skin with temporalis fascia during a nose job.
Thick skin may make it difficult to create definition. For these reasons, there are special steps he takes to create definition in thick-skinned patients.
If there is an obvious deformity, then Dr. Kulbersh takes a mental note. During the surgery, the main goal is to ensure to correct the deformity as best as possible.
Frontal View Analysis
From the frontal view of the nose there are many characteristics that Dr. Kulbersh is reviewing:
- Width of the nose- Does the nose need to be narrowed or widened? If so, do the changes need to be in the lower, middle, or upper parts of the nose?
- Deviation of the nose- Is the nose straight? If not, is it crooked because of a depression or the cartilages and/or bones are not in the midline?
- Shape of the tip- Does the tip have definition? How wide or narrow is the tip? Is the tip symmetric? How does the light reflect off of the tip?
- Nostrils- Are the nostrils symmetric? Can you see inside of the nose? Are the nostrils wide?
Lateral or Profile View
When looking at lateral or profile view, characteristics that Dr. Kulbersh is looking at are:
- What is the angle from where the nose meets the forehead? Is the angle deep or shallow? At what location does this angle start? Does it start high or low when compared to the location of the eye?
- What is the angle from where the nose meets the lip? Is this angle acute or obtuse? Is it sharp or blunted? How does this angle change the length of the upper lip?
- What is the shape of the dorsum or top of the nose? Is there a hump? Is the hump composed of cartilage or bone? Could the hump be secondary to a deep angle where the nose meets the forehead?
- How far out does the nose stick out from the face? Does it stick out too far or is it short?
- Does the nose appear long or short from the side?
- What is the relationship of the nostrils from the side? Can you see inside of the nose too much or not enough?
A view of the bottom part of the nose can give rhinoplasty experts valuable information:
- Is the nose straight?
- The shape of the tip? Is it shaped like a triangle (good) or like a trapezoid?
- What is the size and shape of the nostrils?
- What is the width of the base of the nose?
- Is the bottom part of the septum deviated?
- Is the airway open or narrowed?
As a rhinoplasty expert in Charlotte, when Dr. Kulbersh looks inside of the nose, he inspects the openness of the nasal airway. Dr. Kulbersh is also ensuring there is not a mass or something abnormal inside of the nose.
- What is the status of the septum? Is it straight or deviated?
- Are the nasal valves wide and open or narrow?
- Are the turbinates big or small?
The Relationship of the Nose with the Facial Structure
The goal of a rhinoplasty is to create a nose that blends or fits the face. For this reason, Dr. Kulbersh evaluates the entire face to see how the nose “fits”. Some of the areas he is taking into consideration are:
- The strength or weakness of the chin
- The slope of the forehead
- The width of the face
- The height of the face
- The width of the eyes
- Overall shape of the face
Take Home Points
We hope from reading this blog, you, as a patient, can understand the importance of a thorough nasal analysis and the many details that Dr. Kulbersh is considering during a rhinoplasty consultation. We combine this evaluation with the patient’s goals and wishes to create a surgical plan. To learn more about rhinoplasty, visit medlineplus.gov