Hi, it’s Dr. Salemy, we’re in our office in Seattle and we’re about to do a rhinoplasty on this patient and I wanted to show you kind of what we’re going for.The main issue with her nose is the tip. What I mean by that is she’s got too much cartilage at the tip of the nose and a little bit more cartilage on her left compared to her right. Also the nose is relatively wide for the rest of the base of the nose is really wide compared it to the rest of it.
We’re really focusing on the tip and our goals are going to be to make the tip smaller and to narrow the base of the nose. We’ll go ahead and get to started here [to] show you what we can do.
Okay, so now what we’ve done – we clean up this cartilage and my marking shows where we’re going to remove some excess cartilage. Then what I do is I just make a little incision like this. Okay, so now we’ve trimmed it. You can see we have the cartilage that we’ve left behind, this is just the lining of the nose so we’re going to now repeat the same thing on the other side.
Okay, so now we put one stitch in on this side and then we’re going to pass it to the other side. Like so, now, we’re going to repeat it on this side. Now we’re going to do the same thing on this side. We’re going to put a little stitch in, first like so and then and one more back this way and then we’re going to pass it to the other side. Then we’ll finish putting that stitch in from this side.
As we bring this stitch together we should be able to have some better definition of the tip. If you could just bring the camera down like this, you can see the tip low there. Now we can see that the tip definition is much nicer.
Okay, so now we finished the tip and what we’re really going to work on now is the base. What the patient didn’t like was that her nose was really wide and flared. So we’re going to do two things, we marked where we’re going to remove a little bit that extra skin and after we do that, we’re going to actually place a permanent suture underneath, it’s called a cinch suture to try to narrow this a little bit more for her.
Okay, so now what we’ve done is we’ve reduced the alar base but if we just close this, it can relax over time and splay back out. So we’re going to place the suture called alar cinch suture from one side to the other underneath the skin, so I’ll show you how to do that just now.
We placed the suture on one side and then we’re going to pass it through a Keith needle, which is what this is. Then I’m going to take Keith needle and pass it to the other side. We have to do this with this needle because it’s a straight needle so we can span the distance between one side to another. Let go of that. And that will get us this needle on this side. Now we’ve come to this side, we grab the other side as well and now we’re going to pass it back to the Keith needle so that we can deliver the needle to the other side, so we can close it up.
Here we go. So now we’ve completed this, we’re just going to tie it down and you can see how as I cinch this, I can make it really tight, I can make it a little bit narrower, I can kind of control how wide this is but we really created a nice definition there, so we’re just going to tie this down.