Excisional Rhinoplasty vs. Structural Rhinoplasty

People who are contemplating rhinoplasty have at least two options. They are excisional or structural rhinoplasty. This article attempts to explain the difference between the two.

Excisional Rhinoplasty

Excisional rhinoplasty is when the plastic surgeon removes a substantial amount of bone or cartilage in the nose in order to reshape it. The scar tissue that eventually forms pulls the nose into a shape that’s pleasing for the patient. The problem is that eventually, after months or even many years, the scar tissue no longer supports the nose the way it used to, and the nose can become deformed. Despite this, many doctors still perform excisional rhinoplasty.

Structural Rhinoplasty

To avoid the pitfalls of excisional rhinoplasty, more plastic surgeons are turning to structural rhinoplasty. The rules for this type of surgery are to retain, reposition, reshape and reinforce the nose. Structural rhinoplasty is more challenging to perform than excisional rhinoplasty, but it preserves much of the internal cartilage and bone of the nose while making it aesthetically pleasing to the patient. Structural rhinoplasty also guards against the consequences of ageing, which tends to weaken bone and cartilage. A nose that’s been treated with excisional rhinoplasty can eventually collapse even decades after the surgery. This is not only unattractive but may affect the way the patient breathes. It may necessitate them coming back to the doctor for more surgery.

Patients who have already have weak cartilage in their nose also benefit from structural rhinoplasty because the nose cartilage can be strengthened by grafts from other parts of their body such as their rib, septum or ear. The new cartilage is sutured in place and eventually assimilated into the cartilage that’s already there. This grafting is especially useful for the tip of the nose, where the cartilage is weak.

Done skillfully, cartilage grafting gives the nose a more natural look. It won’t have those telltale signs that it’s been operated on such as overly large nostrils and a pinched look. These signs are common in excisional rhinoplasty unless the surgeon is very talented.

Excisional rhinoplasty is easier for the surgeon to perform, but tends to fail over time due to the amount of bone and cartilage that have been removed. Structural rhinoplasty tries to preserve as much bone and cartilage as possible while creating an attractive nose.

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