"Rhinoplasty for Teenagers Calls for Structural Grafting For Better Long-Term Outcomes," says Dr. Dean Toriumi, Highly Regarded Chicago Reconstructive Surgeon.

    MARINA DEL REY, CA, February 26, 2010 /24-7PressRelease/ -- Dr. Dean Toriumi offers great insight into the subject, "Teenagers who undergo rhinoplasty, the process of change and healing is complex. Younger patients have a longer duration of time which contracture from a scar may contribute to deformities, so it is highly advisable to use as structural approach in younger patients," says Dr. Dean Toriumi.

"There are multiple variations determining long term outcomes in this highly complex surgery," claims Dr. Toriumi. Dr. Dean Toriumi continues, "The nose tends to change for many, many years, so the younger the patient, the more likely a problem will occur.

"This is why a structural approach is necessary for teenagers. Teens that undergo rhinoplasty are more likely to suffer pinching or collapse over time," says Dr. Toriumi. "Many individuals who have rhinoplasty as a teen require secondary rhinoplasty over time. They are also more likely to have difficulty breathing, nasal deformities and other problems due to collapse of their nose."

"The reason for this significant change in teenage patients is because over time, noses that are subjected to rhinoplasty are weaker due to the removal of tissue," says Dr. Dean Toriumi. "In many cases, these changes occur gradually over time. Many patients, for this reason, do not even realize their nose is changing," says Dr. Toriumi.

"Changes over time can be favorable or unfavorable due to rhinoplasty surgery. There is initially a period of time where swelling will go down. The time for this to occur always varies from patient to patient depending on the thickness of the skin on the nose, the thicker skin taking longer," says Dr. Toriumi.

Dr. Dean M. Toriumi continues, "This effect can improve the appearance of the nose, as tip definition increases. But if this effect is excessive or acts on the weakened nasal structure, pinching or a collapse of the nose can occur." Dr. Dean Toriumi explains, "These effects occur over time and younger patients have a longer period of time where scar contracture can deform the nose."

"We've found that with a structural approach, incorporating cartilage grafting actually strengthens the nose so that the contracture effect is less likely to collapse of pinch the nose," says Dr. Toriumi.

Dr. Toriumi uses spreader grafts, lateral crural strut grafts, alar batten grafts and alar rim grafts. In combination, these grafts increase the strength of the nasal structure.

"The grafts make the nose look initially a little larger but as time passes the reduction in swelling and in combination of the scar contracture effect, the shape of the nose is improved. Noses structured over time improve instead of looking good at first and going bad later," says Dr. Toriumi.

"Patients with thin skin are at a higher risk of undergoing unfavorable changes over time," says Dr. Toriumi. "Even the slightest irregularities show up more over time. Those with medium or thick skin typically do better as irregularities tend to be more hidden. Because of this phenomenon, Dr. Toriumi takes more time, adding extra structure to patients with thin skin.

Additionally, patients with unfavorable anatomy, i.e., short nasal bones or bulbous tip cartilages can also have problems over time, noted Dr. Dean Toriumi. "Those with shorter nasal bones will tend to collapse in the middle portion of the nose," he states. To prevent these problems, Dr. Toriumi will typically not reduce the cartilages as much as he will support and reshape the cartilages using cartilage grafting and suture.

After placing these cartilage grafts, Toriumi says, the nose can feel stiffer and be more swollen at first. For most patients, however, this is an unacceptable trade-off for a good long-term outcome. Dr. Dean Toriumi says, "In teenagers, this approach is very bothersome as most patient this age do not want to trade off looking good now for looking good later. In this case, we will take the time to narrow and define the cartilage."

"Teenagers tend to compare their outcomes and seem to think whoever has the initial better result got the better nose job," says Dr. Toriumi, "when we follow up with patients over the years, many of them have problems just a couple of years later."

Toriumi says that surgeons who produce the highly refined short-term outcomes for their patients tend to have favorable reputations, but they this approach is short-sighted. "No matter the patient," says Dr. Toriumi, "he or she deserves treatment that is likely to produce the best long-term outcome, with minimal need for a secondary rhinoplasty."

Dr. Dean Toriumi has seen this dynamic first-hand and in many cases. A number of patients who chose another rhinoplasty surgeon for their short-term results often return to him later for a secondary rhinoplasty, he states.

The patient shown above underwent rhinoplasty as a teenager. Two and a half years postoperative, she is doing well with no evidence of collapse with excellent nasal breathing.

For more information please see http://www.deantoriumi.com/

Dean M. Toriumi, MD
Facial Plastic and Reconstructive Surgeon
900 N. Michigan Ave.
60 East Delaware Street, Suite 1460
Chicago, IL 60611

312-255-8812

Email: [email protected]

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