2. Preoperative Planning

Hello.

I am Dr. Young-moon Yoo, the Chief Director of VIBE Plastic Surgery.

Last time, we looked into the anatomy of the nose.

(If you are curious, please click below)

Today, I will discuss what I look for first when I meet patients for a consultation and how I establish a surgical plan.

1. Bone and Skeleton: Asymmetry, deviation, or presence of a hump 2. Cartilage: Thickness and strength 3. Skin: Thickness and elasticity 4. Revision Status: Types of implants or cartilage previously used 5. Preferred Line

1. Bone and Skeletal Evaluation

- I examine the nose from the front, 45-degree angle, and side.

- I evaluate whether there is skeletal asymmetry, if the axis is straight (or deviated diagonally), and if the nasal bridge is uneven due to a hump.

- No one in the world has a perfectly symmetrical nose as if drawn with a ruler. The slope and thickness of the nasal bones on both sides differ based on the central axis.

- It is crucial to meticulously check for these asymmetries before surgery, and both the patient and the surgeon must be aware of them together.

- For an accurate diagnosis, it is essential to directly check the skeletal structure through 3D CT imaging.

2. Cartilage Evaluation

(1) Septum

- First, I press firmly on the tip of the nose. This is the easiest way to gauge the strength of the septum. I assess whether it has good supporting strength or if it collapses easily under finger pressure.

- To accurately evaluate the size and degree of deviation of the septum, we use 3D CT and endoscopy. Checking the size and deviation in advance and planning the surgery accordingly is a vital process to increase surgical precision!

(2) Alar Cartilage (The part forming the nostrils)

: I evaluate the strength and thickness of the cartilage.

: If the nostrils appear severely ‘pinched,’ we must create a beautiful nostril shape through alar rim lowering.

: Since the shapes of the left and right cartilages differ, explaining this part is also very important.

(3) Ear Cartilage

- I evaluate the size, thickness, and strength of the ear cartilage in case it needs to be used.

- In the case of revision surgery, I must check if it has already been harvested.

- For those with many piercings, I plan how to make the incision and harvest the cartilage while avoiding those areas.

3. Skin

- I evaluate the thickness, elasticity, and amount of available skin.

- This is a particularly crucial step in diagnosing ‘bulbous nose’ surgery. Since there may be limitations for those with very thick skin, an explanation regarding this is mandatory.

- In revision cases or when a significant increase in tip height is desired, checking for sufficient skin laxity is vital.

- In relation to this, smoking status must be confirmed. Since smoking is the biggest factor in skin necrosis of the nasal tip, you must quit smoking for at least 2 weeks before and 2 weeks after surgery! It would be even better to quit entirely this time, right?

4. Revision Surgery Status

- For revision cases, I must identify why and for what specific reasons the patient wants surgery again.

- Whether the implant has shifted, the height is unsatisfactory, or it is due to the shape and angle of the tip... the reasons for seeking revision are incredibly diverse!

- Among these, I believe the most important thing is to evaluate ‘whether revision surgery is truly necessary.’ We should not recklessly perform surgery on a nose that doesn't need it! If it is unnecessary, I must persuasively explain why it should not be done.

5. Preferred Nose Shape and Line

- I check preferred lines such as straight-semi-basal, semi-basal, or straight lines. Since everyone's desired shape is different—whether they want a sharp tip or a naturally rounded one—it is very important to find each individual’s unique charm and beauty.

- Referring to photos of celebrities or influencers is also helpful.

- If you don't have a specific line in mind or are unsure, it is essential for me to recommend a line and coordinate our opinions together.

Click the following to see various rhinoplasty cases.

Today, we looked at what points to consider when performing rhinoplasty...

Specifically, ‘Preoperative Planning.’

I imagine many of you already knew much of this, while for others, it was very helpful information.

In the next episode, I will explain various rhinoplasty methods in an easy-to-understand way.

See you next time!

Right Thinking, Right Surgery – Young-moon Yoo