Rhinoplasty for the Nasal Bridge
The nasal bridge is the other major component of the nose during rhinoplasty. Modification may involve straightening a crooked nose, lowering a nasal hump, or raising a flat nasal bridge. There are many permutations of these three techniques where Dr. Lam may also straighten a nose, lower a hump and raise a portion of the nasal bridge all for the same patient. Like the nasal tip, this section will only cover some of the salient methods that he uses to modify the nasal bridge. There are too many methods to recount in this section, but Dr. Lam will discuss with you some of these methods during his consultation, so it may be worth reading this section or reviewing it after a discussion you have with him.
Nasal Hump Reduction and Osteotomies
When performing a nose surgery, Dr. Lam is careful when he reduces a nasal hump, nasal bump, to ensure that he leaves behind a straight bridge, as his mentor always said, “God never made a scooped nose, only man has.” The nasal bridge reduction almost always must include narrowing the nasal bones (known as osteotomies) because once the nasal hump is removed, there is a so-called “open roof” and the nasal bones must be narrowed to close this gap. The nasal hump reduction must also be performed to such an extent to match the nasal tip size and shape, as an overaggressive reduction will leave the nasal tip looking too large. Sometimes what appears to be a nasal hump may only be a low radix (a low bridge in the upper portion between the eyes) and raising this area can make the hump virtually disappear. At times, it requires a little of both methods. Osteotomies can also be performed separately simply to straighten a nose or combined with other techniques to achieve the desired nasal bridge height, shape, and straightness.
Lateral Defining Osteotomies
At times, the nasal bridge does not need to be lowered but only narrowed slightly. This is performed by only narrowing the outer portion of the nasal bones, and this procedure is oftentimes performed with elevation of the nasal bridge (see below) in ethnic rhinoplasties (and some Caucasian rhinoplasties too) to achieve the best balance between height and narrowness of the nasal bridge.
Diced Cartilage/Tissue Glue Bridge Elevation
In the past, Dr. Lam used synthetic nasal implants to raise the nasal bridge. Twenty years ago he used solid silicone implants but had complications that involved infection, displacement, and shrink wrapping. For a decade he used Gore-Tex implants with great success but still felt that the implants slightly pinched inward over time. He now uses diced cartilage, diced down to a fine degree, so that there are no visible edges to build the bridge. For years he used temporalis fascia (the lining of the temporalis muscle) but for the past few years the use of an advanced tissue glue has eliminated the need for harvesting this fascia. Furthermore, the tissue glue (which dissolves in a few months’ time) allows a more precise level of fine tuning the desired shape and height. Diced cartilage also appears much softer and more natural in the bridge, does not warp like solid implants or become displaced and has limited resorption over time. It has become the preferred method for nasal bridge elevation and definition used in ethnic rhinoplasties (African rhinoplasty, Asian rhinoplasty, Hispanic rhinoplasty, etc.) and in some Caucasian rhinoplasty as well. It is the state-of-the-art method of nasal bridge elevation and enhancement.