Win by a Nose

Created on 05th March 2009

Dr Roger Amar of the Amar Clinic in Marbella explains to Cosmetic Surgery & Aesthetics Magazine his innovative approach to rhinoplasty

Cosmetic surgery to the nose is a very popular procedure that can make profound differences, not only in the balance of facial features, but also to a person's self-esteem. Rhinoplasty either modifies the appearance of the nose (partially or totally) or is aimed at correcting possible problems of nasal breathing or is undergone to achieve both of these outcomes.

The defects that are corrected can either be of congenital origin, due to a trauma or due to changes that occur as a result of ageing. Patients who are interested in rhinoplasty usually have a definite idea as to how they would like to improve or refine the shape of their nose. Often they don't like the 'nasal hump' on the bridge, the thickness of the nasal tip or the width of their nose.

The nasal septum (the structure that separates the two nostrils inside the nose) is composed of cartilage and bone. It may become deviated, either through the trauma of birth, or as the result of an accidental injury. This deviation may alter the pattern of air flow through the nose, making it difficult to breathe. In addition, the nose may appear crooked with a 'hump'.

Reduction of the 'nasal hump', refinement of the nasal tip, narrowing of the width and straightening of the nose are combined into one procedure. In order to eliminate visible scarring, the nasal surgery is done through the eyelids and from within the nostrils. The goal is to achieve a more natural appearance, without a 'turned up' or artificial look.

My personal goal is always to obtain the most natural appearance of the nose, in harmony with the characteristics of the facial features and according to the patient's personality and expectations.

The classic rhinoplasty procedure involves incisions disguised in the nasal grooves that allow the surgeon to remodel the bone and the cartilage that are the solid infrastructure of the nose. However, the fracture or osteotomy of the bone is done from a parallel position to the nasal bone which does place restrictions on the access of the surgeon and there is the risk of producing small bone fragments.

Dr Roger Amar's procedure

When carrying out rhinoplasty, I always aim to obtain the best possible result, to smooth out the expression of the face, to avoid hematomas (a localized swelling filled with blood) and pain and to shorten the period of post operative recovery. Where I differ in my approach to some surgeons is by making a mini incision in the inferior eyelid in order to treat the base of the nasal bones. This technique allows an easier recovery and contributes to the naturalness in the result. This transpalpebral osteotomy (rhinoplasty through the eyelid) avoids complications and annoyances of all kind.

The advantages of this technique

The surgeon accesses the nose from the side so it is possible to have much greater precision when fracturing the nasal bone and avoids the bone being broken in to small pieces.

• Avoids bleeding, hematomas, pain after the operation and the recovery process is much easier.
• The incision - of 2mm - does not require sutures and disappears after a few days.

When is it best to embark on rhinoplasty

Men and women, from the age of 16 years (once they have passed puberty), are suitable candidates for rhinoplasty. I don't really recommend it to patients after the age of 40 (except where I am carrying out a total face rejuvenation, which involves lifting and my own technique of FAMI or Fat Autograft Muscle Injection). I believe that to change the appearance of the nose in a mature person can bring about psychological trouble, since the image of the nasal appendix is determined deeply in the brain.

The results of rhinoplasty

The vast majority of rhinoplasty patients who choose qualified surgeons to perform their surgery are satisfied with their results. In many cases, slight changes to the structure of the nose - sometimes as little as a few millimetres - can produce drastic and pleasing results.

Secondary rhinoplasty

In order to correct unsatisfactory aesthetic results of an operation to the nose, I often employ my FAMI procedure, which makes it possible to rebuild the structure of the nose by injecting adult stem cells from the patient's own fat, using new tissues to correct defects.