56. Elastic rhinoplasty with removal of a cartilaginous hump and correction of the anterior septum
KEYWORDS: elastic rhinoplasty, Elasticum, elastic thread, two-tipped needle, Jano needle
A long nose can be shortened by implanting an elastic thread through a 2 mm incision or through the hole made by a 16 or 18 G needle. Elastic lifting of the nose, or elastic rhinoplasty, has an effect that is not only esthetic, but also functional; by correcting the nasolabial angle, this procedure also improves the patient's breathing.
This patient's nose has a drooping tip, an evident cartilaginous hump and an anterior deviation of the septum. After drawing the pathway of the elastic thread and carrying out local anesthesia, we remove the cartilaginous hump. Using a n°15 scalpel blade, we make an intercartilaginous incision, which does not interfere with the passage of the elastic thread. Scissors are used to dissect the skin from the cartilaginous hump. A n° 11 scalpel blade, the tip of which has been snapped off, is used to cut away the excess cartilage from the bridge of the nose. The fragments of cartilage are freed with the aid of scissors. The prominent hump is removed with pincers.
Once the 2 mm skin incision has been made between the nasal bones and the frontal bone, the operator anchors the elastic thread to the deep tissues of the procerus muscle. The elastic thread follows the direction of the previously drawn line. The elastic thread is pulled through. The Jano needle is rotated through 180° while about 4 or 5 mm of the tip remains in the tissues. The pathway of the needle runs between the skin and the cartilages.
The operator must be very careful not to allow the two-tipped Jano needle to come out of the skin. If the needle does come out, the elastic thread must be extracted and re-implanted. An important feature of the elastic thread is that it does not cut into the tissues. Moreover, once its outer sheath has been colonized by connective cells, the thread becomes a sort of ligament. The elastic thread mounted on the two-tipped needle has enabled us to perform new mini-invasive lifting procedures for the face and body.
When the two-tipped needle is close to the procerus, it passes through the deep tissues of the bridge of the nose, in order to improve the anchorage of the elastic thread. From here, the needle is extracted through the small entry incision.
The elastic threads are placed under tension and knotted, under the guidance of the tip of a Klemmer. A small wad of hemostatic collagen is inserted into the cavity, in order to keep the knot in a deep position. The 2 mm incision is sutured.
We then correct the anterior deviation of the septum, which has become evident now that the tip of the nose has been lifted. The result.
Capurro S. (2022): Elastic rhinoplasty with removal of a cartilaginous hump and correction of the anterior septum CRPUB Medical Video Journal. Elastic Plastic Surgery section. www.crpub.org.
What pre- and post-operative prescriptions are necessary?
In this procedure, pre- and post-operative prescriptions/instructions are important. As 30% of individuals have staphylococcus aureus in the nose, the patient must carry out targeted antibiotic prevention both before and after elastic rhinoplasty. This can be done by applying a topical antibiotic. Specific antibacterial vegetable extracts (Angiovein capsules) can also be taken.
(Obviously, if the patient has an ongoing infection of the facial skin, it is advisable to postpone the procedure until the infection has completely resolved.)
What advice can you give regarding this procedure?
In this procedure, we correct some defects of the nose, a cartilaginous hump and the anterior deviation of the septum, without crossing the pathway of the elastic thread. We do not want to create any communication between the pathway of the thread and the outside. It is also possible to reduce a bony hump and to create a green stick fracture of the ascending processes of the maxilla (with a 2 mm external chisel).
The best elastic thread to use is the Elasticum EP3.5. The tip of the nose must not resist lifting. If there is any resistance to the lifting of the tip, the anterior septum will need to be reduced.
To create the access for the thread, we no longer make a micro-incision with a micro-blade; we prefer to use a simple 16 G or 18 G needle, as this leaves no scars. We have improved the anchorage of the thread to the deep tissues of the procerus by passing the two-tipped needle through the tissues twice in a zigzag manner, as can be seen in the video publication.
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