| RHInOplasTy | aRTiCLE
a hanging columella, depressed tip, large dorsal hump, or obliteration of the frontonasal angle (Figures 3 and 4). Excision of a wedge from the caudal part of the septum
will correct the depressed tip along with the hanging columella, resulting in a shorter appearance of the nose. This wedge is in the form of a triangle with the apex directed inferiorly and the base anteriorly. The length of the base correlates with the intended degree of shortening required. Cartilage should be precisely measured and excised to avoid showing the nares, which is unacceptable to the patient. a small piece of septal mucosa in the same shape is removed from the upper edge of the transfixion incision on both sides for the same purpose. This helps to shorten the nose, decrease sight of the columellar, open the nasolabial angle, and allow cephalic rotation and correction of a plunging nasal tip. Rasping is usually sufficient to correct an obliterated frontonasal angle. an important point is to avoid alar incisions in cases
where a transfixion incision of the septum was performed, and to avoid jeopardising the blood supply to the nasal tip.
Hanging (pendant, drooping) tip a pendant low tip is also a standard feature of the long, slightly humped arabic nose. The tip is more caudal than normal, and under‑projected at the same time. The nasolabial angle is abnormally small. a pendant tip is often seen in elderly individuals combined with a long nose. If the previous measures were not sufficient to correct
a depressed tip, occasionally the authors would manage this problem by inserting a cartilaginous strut harvested from the septum or the helix. In cases with a broad tip, a domal suture was carried out to elevate and narrow it.
Dorsal hump a mild hump was simply rasped, taking care to preserve the roof of the nasal pyramid (Figure 5). In more severe cases, osteotomies were performed to prevent open roof deformities. spreader grafts are often needed to camouflage an open roof. In most cases a combination of these techniques was required to achieve the desired result.
The intranasal Merocel pack was removed on the first
postoperative day immediately before discharging the patient from hospital. The external nasal splint was changed on the second postoperative day in order to check for any nasal deflections or deviations. The new splint was then removed 1 week later. Oral acetaminophen was prescribed for postoperative
in certain cases, the nose may appear longer than normal in
relation to the rest of the face. This may be the result of a hanging
pain, and swelling and bruising were managed with warm and cold compresses. The use of gauze‑wrapped tea bags as warm compresses is particularly helpful to reduce postoperative swelling owing to the astringent properties of tannic acid. Complications encountered were
columella, depressed tip, large dorsal hump, or obliteration of the frontonasal angle.
uncommon and minor; bleeding was controlled with nasal packing and rarely, bipolar cautery. no postoperative infections or adhesions were noted. One patient had a small asymptomatic septal perforation as a result of excessive use of diathermy to control troublesome bleeding from little’s area.
Results The majority of patients were satisfied with the balanced, natural look of the nose and absence of the operated look, or any of post‑rhinoplasty stigmata, such as polybeak deformity, saddle nose, or a pinched look. a difference between the preoperative and
postoperative appearance was appreciated, and the identity of the arabic nose was preserved. Five cases were not satisfied with the postoperative results and refinement surgery was carried out 3 months later.
Discussion Certain standard features characterise the arabic or Middle Eastern nose. In most cases, these features can be easily corrected using a few simple endonasal procedures. The principle of ethnic rhinoplasty is to correct
Figure 4 Pre- (A and B) and postoperative (C and D) images demonstrating correction of an excessively long nose with a pendant tip
perceived abnormalities without transforming the ethnicity of the nose. The traditional European view of the perfect nose with a slender dorsum and a slightly upturned tip would only look odd in the setting of a clearly arabic face. It is vital to be flexible and not to strictly adhere to the known standards of what is considered the ‘perfect’ nose in the traditional literature. This balance can only be achieved with practice and resisting the impulse to overcorrect.
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