What Century Does Your Rhinoplasty Surgeon Operate in?

Since the late 1800s, rhinoplasty has involved a surgeon’s breaking the bone in a patient’s nose and (one hopes) rebuilding it into a shape the patient wants. Even though cosmetic nose surgery has become much more popular since about the 1950s and we’ve had decades of advancement in medical understanding and technology, most patients are stuck with the same basic rhinoplasty procedure they would have had over 100 years ago.

The main reason most people don’t have any other rhinoplasty options is that most plastic surgeons in the US don’t offer any other rhinoplasty options. They offer “traditional” rhinoplasty, with its old approach to cutting bone, its tendency to cause swelling, and its longer recovery times. It’s hard to find facial surgeons who use the two great rhinoplasty innovations of the 21st Century: the ultrasonic and preservation techniques.

Dr. Michel Siegel not only offers ultrasonic rhinoplasty and preservation rhinoplasty, but all of his rhinoplasties involve those two modern (yet hard-to-find) surgical techniques. The main (but not only) benefit of both is that they are gentler, cause less swelling, and have a shorter recovery time. Most of the surgeons who offer preservation and ultrasonic rhinoplasties are in Europe or Turkey. Very few are in the US, and even fewer practice here in Texas. If you’re in the Houston area or willing to come here, you’re in luck. Contact our office today to schedule a consultation with Dr. Siegel, or read on to find out more.

Early History of Rhinoplasty

Early rhinoplasties were performed to replace a nose lost to illness or injury rather than improve aesthetic appearances. The first records of rhinoplasty go back to 3,000 BCE in Egypt. 

The 19th Century

It was not until the 19th century that rhinoplasties were being performed for cosmetic rather than reconstructive purposes. In 1887, Dr. John Orlando Roe performed the first closed rhinoplasty. Two years later, Jacques Joseph, considered by many to be the father of modern rhinoplasty, performed a rhinoplasty on a 28-year-old man who was so embarrassed by his nose’s size that he would not go out in public.

The 20th Century

By the 1950s, several Hollywood stars began to undergo rhinoplasty for cosmetic reasons. John Wayne, Gary Cooper, Marilyn Monroe, and Rita Hayworth were among the notable celebrities who had their noses reshaped.

Prior to the 1980’s cosmetic rhinoplasties were closed rhinoplasties- no incision made in the columella-the skin in between the nostrils. The downside of this approach was the limited access to the nose-no fine tuning was possible. 

The 1980’s saw the development of the open rhinoplasty technique-by making an incision between the nostrils, the surgeon had better visualization of the anatomy, and more precise changes could be made. 

The 21st Century

The two most important advances in rhinoplasty have been made just in the last 10 years. 

Preservation Rhinoplasty (PR): In the last decade or so we’ve gained a better understanding of the nose support structures, such as ligaments, that were previously destroyed with all previous rhinoplasty methods.  By “preserving” these supportive “skeletons” of the nose, the preservation technique prevents the dreaded results traditionally associated with rhinoplasty surgery: pinched, collapsed, overly small, and asymmetrical noses.

The same tools – mainly saws and chisels – used for reshaping the nasal bones have changed little since the last century. “Breaking the nose” with these tools invariably results in the traditional long-term bruising and swelling often associated with rhinoplasty. Which leads us to the second major advancement in rhinoplasty, incorporated less than a decade ago: Piezo, or Ultrasonic Rhinoplasty (“US”). 

Ultrasound vibration, rather than antiquated instruments, is used to reshape the nasal bones, preventing the traditional black and blue eyes, and the long-term swelling associated with this surgery.

Preservation and Ultrasonic rhinoplasty were developed in Turkey and France, respectively, and they are becoming the standard for rhinoplasty in the rest of the world. The bad news is that these advancements have adapted only slowly and spottily by US facial surgeons.

Why? For one thing, there are very limited resources in the US to learn next-level surgical concepts and techniques. One must travel to Turkey, and or Europe to learn, and take the time to master these philosophies. As with other habits, it is hard to break routines that have been practiced for decades, even if they do not produce the best results.

Incorporating these techniques also requires a complete new set of instruments that are not readily available in the US. They must be brought from Europe and Turkey.

Since 2018 I have practiced Preservation and Ultrasonic rhinoplasty for my patients. Preservation and Ultrasonic rhinoplasty are not merely new “techniques” or temporary trends.  They are based on a better understanding of the nose, based on concepts that were not in older medical or anatomy books. 

Having incorporated Preservation/Ultrasonic rhinoplasty into every rhinoplasty I perform, I have seen better aesthetic and functional (breathing) outcomes, shorter recovery times with less swelling, and results that hold up long-term.

While most surgeons in the US still offer traditional open and closed rhinoplasty approaches, I have little doubt that these 21st-Century surgical techniques will become the norm and the standard. But we may need to get through more of the 21st Century first.

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