Structural Grafting in Rhinoplasty for Teenagers Provides a Better Chance for Successful Long-Term Outcomes, Says Highly Regarded Physician Dr. Dean Toriumi

    MARINA DEL REY, CA, January 10, 2010 /24-7PressRelease/ -- So for teenagers who undergo rhinoplasty, the process of change and healing is doubly complex. Younger patients face a longer time during which contracture from a scar can contribute to deformities of the nose, so a structural approach to rhinoplasty in younger patients is highly advisable, argues Dr. Dean Toriumi, a noted facial plastic surgeon at the University of Illinois at Chicago.

"Rhinoplasty is highly complex, with multiple variables dictating long-term outcome," Toriumi said. "Some patients have good short-term outcomes then develop significant problems over time. The longer a patient lives, the more likely a problem with the nose will occur because after rhinoplasty, the nose will tend to change for many years."

"That is why a structural approach is optimal for younger patients. Because teens' noses change independent of surgery, for those who undergo rhinoplasty it is particularly important to structure the nose so that there is less likelihood of collapse and pinching over time. Too many individuals who have rhinoplasty as teenagers need secondary rhinoplasty as adults after they face difficulty breathing, nasal deformities, and other problems due to the collapse of their nose."

The reason for significant change in teenage rhinoplasty patients over time is because most noses are weaker after rhinoplasty due to the removal of tissue. The result can be deficient areas that are placed under the influence of healing and scarring, Toriumi noted. In many cases the changes occur gradually over years. For this reason many patients do not even realize that their nose is changing, he said.

"When rhinoplasty surgery is performed on the nose, changes that occur over time can be favorable or unfavorable. Initially there is a period of time where the swelling goes down. This can vary from patient to patient depending on nasal skin thickness, with thicker skin taking longer. There is also scar contracture where the layer of scar over the nasal structures contracts, creating a 'shrink wrap' effect."

Toriumi added that this effect can improve the way the nose looks, as tip definition increases. But if the "shrink wrap" effect is excessive or acts on a weakened nasal structure, collapse and pinching of the nose can occur, he said. Because these effects occur over time, younger patients can face a longer period of time during which the scar contracture can deform the nose.

"We've found that a structural approach incorporating cartilage grafting supports and actually strengthens the nose so that the scar contracture effect is less likely to collapse or pinch the nose," Toriumi said. He uses spreader grafts, lateral crural strut grafts, alar batten grafts, and alar rim grafts. In combination these grafts increase the strength of the nasal structures and decrease the likelihood of collapse over time, he says. "The grafts can make the nose look a little larger initially but as time passes, the reduction in swelling in combination with the scar contracture effect improves the shape of the nose. Noses structured in this fashion improve over time instead of looking good initially then going bad years later."

There are characteristics of certain noses that are at higher risk of undergoing unfavorable changes over time, Toriumi said. Patients with thin skin are at higher risk for problems, as even the smallest irregularity can show up over time. Those with medium or thick skin will tend to do better over time as the irregularities will tend to be hidden under the thicker skin. Patients with thicker skin will tend to stabilize at some point and may do well as the years pass, Toriumi said. For this reason Dr. Toriumi will take extra time and add more structure to noses with thinner skin and unfavorable anatomy.

Additionally, patients with certain unfavorable anatomy such as short nasal bones and bulbous tip cartilages can have problems with collapse and pinching over time, Toriumi noted. "Those with shorter nasal bones will tend to collapse in the middle portion of the nose. This can be prevented by placing spreader grafts in the mid portion of the nose. Patients with bulbous tip cartilages that have been reduced during surgery will tend to pinch in the tip with nostril exposure. To prevent these problems, we do not reduce the cartilages as much as we support and reshape the cartilages using cartilage grafting and suture methods."

After placing all of these cartilage grafts, Toriumi says, the nose can feel stiffer and can be more swollen initially. However, for most patients, he added, this is an acceptable trade-off for a good long-term outcome. "In teenagers, this approach can be very bothersome as most patients in this age range want to look good immediately. In most patients the profile will look good quickly, whereas the front view will take more time to narrow and define."

"Teenagers always compare their outcomes and seem to think that whoever has the better early result had the better rhinoplasty. It is very revealing when we follow up with these patients to see how they did over the years. Frequently, the patients who looked narrow and refined right after surgery end up with problems a couple of years down the line."

Toriumi added that surgeons who produce the highly refined short-term outcomes in their teenage patients tend to generate favorable reputations. But Toriumi believes that approach is short-sighted. "No matter the patient, he or she deserves treatment that is likely to produce the best long-term outcomes, with minimal risk of or need for secondary rhinoplasty," he said.

He has seen this dynamic first-hand, he says, in a number of patients who return to him for consultations after having opted for another rhinoplasty surgeon. Short-term results may have been good, but when their noses have not turned out well over the longer term, through collapsing or pinching over time, Toriumi sees them for a secondary rhinoplasty.

The patient shown below underwent rhinoplasty as a teenager. Now two-and-a-half years postoperative, she is doing well with no evidence of collapse and enjoys good nasal breathing.

For more information, please contact Dr. Dean Toriumi, MD
(312) 255-8812

60 East Delaware Place, Suite 1460
Chicago, IL 60611

email: [email protected]

Or visit our website at: http://deantoriumi.com/


or email [email protected] for an appointment.

Call (312) 255-8812

# # #