The next step is to carve the cartilage so we can use this for grafting. I am carving what we call a columella strut. This is something that we are going to put in between the cartilage to help lift it. If you notice I am just very delicate and very careful and very meticulous when I carve this because this cartilage is not very thick. I want to make sure that I do not make it too thin. We can’t have it too thick, we can’t have it too thin.
This is our columella strut. I will show you where we will place that in a minute. We might have to use this to make something called a shield graft. That would give the tip more projection and definition.
Now we are going to insert the piece of cartilage in the little pocket here and then we are going to stitch everything together. We are placing little sutures. We are gently and carefully and symmetrically suturing this piece of cartilage to the existing cartilage called medial crura. We are trying to elevate the current cartilage to a lot higher level or what we call more projection. This is what is very, very important as part of this case. I have to make sure that everything is very symmetric.
Now we are stitching the medial crura cartilage to the columella strut. We are advancing the natural cartilage onto the strut to give it more projection. Again, if we tent it up, it is like putting a pole over and around the tent and lifting it up and it will appear more narrow. That is our goal.
This is the foundation for this rhinoplasty, this one piece of cartilage. Obviously there will be a lot more but this is what we need to really focus on so that it is nice and symmetric.
It is very difficult to make this part of the surgery absolutely symmetric but our goal is to really do the best we can. What we are trying to do is make everything look good. Symmetry is what this is all about. You have to do it right the first time. If you don’t like it, you go back and do it again.
Already I am seeing some increased projection of the nose and the tip is already appearing slightly smaller. I really like that. That is a good base for us to start with.
When we went in for Erika’s surgery, we had numerous procedures we had to do.
We just finished seeing Erika. It is six weeks following her rhinoplasty surgery. As you can tell by looking at the before and after photographs, her nose looks a lot better and she still has a lot more healing to go.
I am very happy for her right now.
