Last updated date: 16-May-2023
Originally Written in English
A low or broad nose bridge may cause the eyes to look further apart than they actually are, creating a flat profile. If the nasal bridge is not straight, a person may appear too strong or masculine, or more mature than she or he is. Furthermore, it may induce breathing difficulties, rhinitis, or other nasal discomfort.
A nasal deformity is an anomaly in the structure and appearance of the nose that causes breathing difficulties, reduced sense of smell, and other issues.
Patients with nasal deformities are more likely to snore and breathe loudly, have nosebleeds, dry mouth, chronic sinusitis (inflammation of the sinus passages), and get sinus infections. These problems are frequently accompanied with dissatisfaction with the shape and appearance of the nose.
Treatment for nasal abnormalities is not necessary since the condition is rarely life-threatening; rather, it is a matter of increasing quality of life and being able to breathe better, or of feeling more confident in your look. There are therapies available to help with both function and shape.
What Causes Low Nasal Bridge?
When your child is small, you may observe a low nasal bridge. Low nasal bridge is common in some people. However, some potential reasons include:
- Cleidocranial dysotosis. This is a hereditary disorder that results in abnormal bone growth and development. Loose joints, short arms and fingers, and increased bone fractures are further symptoms of this condition.
- Syphilis. If you infect your kid with syphilis before birth, the virus might damage their bone growth. It can also result in an enlarged liver or spleen, as well as fever, irritability, and a rash, among other symptoms.
- The Williams Syndrome. This hereditary condition is distinguished by facial characteristics such as a broad nose, a big mouth, a round face, and round cheeks. People suffering from this illness may also experience intellectual difficulties and delayed development.
- Down Syndrome. This happens if you have an extra chromosome. Down syndrome patients have a wide, flat nose, almond-shaped eyes, and are lower in stature.
- Polychondritis. This condition causes cartilage inflammation.
- Granulomatosis associated with polyangiitis. This disorder affects your blood arteries, causing blood flow to organs and other parts of your body to slow. This decrease in blood flow might result in granulomas, which are inflammation-related growths. These are frequently seen in the lungs, sinuses, and throat.
- Previous Surgery. Prior septoplasty or septorhinoplasty surgery may result in nose saddling. If an aggressive septoplasty is performed that eliminates the entirety of the septum, the nose may weaken and potentially collapse over time. Furthermore, any septoplasty surgeries performed on kids who are too young might result in nose saddling later in life as individuals mature.
- Trauma. The most common cause of nasal saddling is trauma. Any damage to the nose might result in saddling or sagging. When the septum is cracked after trauma, it shrinks, resulting in nasal height decrease.
- Septal Abscess and Septal Hematoma. Blood or pus accumulation in the septum, caused by trauma, surgery, or septum manipulation, may impair blood flow to the septum, resulting in nasal saddling.
- Autoimmune and Vascular Conditions. Autoimmune and vascular illnesses can also cause septal vasculitis (inflammation of blood vessels). This inflammation reduces blood supply to the septum, resulting in tissue necrosis and loss. As the disease progresses, the septum weakens and the nasal height decreases. Wegener's Granulomatosis and Relapsing Polychondritis are two examples of ailments.
- Cocaine Abuse. Long-term cocaine usage reduces blood supply to the nasal septum, resulting in tissue necrosis and loss. This eventually results in nasal septum shrinkage and loss of nasal height.
- Infections. Chronic infections such as syphilis may also compromise blood flow to the nose and septum, leading to nasal saddling.
Symptoms of Low Nose Bridge
Nasal deformities can produce symptoms such as:
- Blockage of one or both nostrils – this can make breathing difficult and is more noticeable when you have a cold or an allergy, which can inflame and narrow the nostrils.
- Bleeding – if the surface of the nose dries up, you may suffer more nosebleeds.
- Facial pain – sometimes a nasal deformity can cause facial pain.
- Loud breathing during sleep – this occurs if the tissue inside the nose is inflamed. It is common in infants and children with a deviated septum.
- Nasal cycle – the nose is usually blocked alternately on one side or the other, which is called the nasal cycle. This is normal, but if it happens very often it can mean an abnormal obstruction.
- Preference for sleeping on one side. Some people prefer to sleep on one side at night to improve nasal breathing, which may be due to a deviated nasal septum.
Material to Augment the Nose
Adding volume to the nasal bridge necessitates the use of material. Many different materials have been utilized over the years, but the three kinds listed below are the most popular. The greatest plastic surgeons will employ a range of materials and tailor the treatment to each patient's specific demands.
- cartilage – patient’s own (septum, ear, rib) or cadaveric (ex. irradiated rib, acellular dermis)
- synthetic solid implant – silicone, ePTFE (expanded polytetrafluoroethylene, Gore-Tex®)
- synthetic gel implant – filler injections (hyaluronic acid, Restylane®)
When possible, plastic surgeons (and patients) prefer natural results and use the patient's own cartilage. During septoplasty, cartilage is extracted from the inside of the nose, the ear, or the rib. Each of these cartilage transplants has its own set of benefits and drawbacks.
Silicone nasal implants are available in a variety of forms and sizes, and your cosmetic surgeon may mould them as needed. The L-shape (augments bridge and tip) and the I-shape or dorsal-shape are the two most prevalent forms (augments bridge only). One reason silicone is a popular solid implant material is its ease of placement and removal. The drawback of silicone is that the implant might become apparent and is susceptible to scar capsule development, infection, or extrusion.
ePTFE, like silicone, is utilized in a range of medical treatments, including cosmetic surgery. ePTFE, unlike silicone, contains microscopic pores that allow for tissue ingrowth without the formation of a conventional scar tissue capsule. After implantation, the substance is permanent and does not deteriorate. ePTFE, unlike silicone, is not known to protrude from the nose. However, this implant is prone to infection and is extremely difficult to remove if necessary.
The most recent materials available for dorsal augmentation rhinoplasty are hyaluronic acid-based synthetic gels (Restylane® and Belotero®). For years, plastic surgeons have used gel injections to repair wrinkles, plump lips, and improve cheeks, but more lately, they have used it on the nose for nonsurgical rhinoplasty.
Indications For Low Nose Bridge Surgery
Patient selection, the surgeon's experience, and the origin of the deformity must all be considered before deciding whether to reconstruct the nose. Surgery might be performed for functional, cosmetic, or both reasons. Here are several examples:
- Nasal airway obstruction secondary to middle vault collapse and/or incompetency of the internal or external nasal valve in a patient with a saddle-nose deformity.
- Nasal airway obstruction secondary to perforation of the loss of septal cartilage in the patient with a saddle-nose deformity.
- The patient's desire for aesthetic improvement.
Persons with contraindications for repairing a saddle-nose deformity include the following:
- Patients with malignant, chronic, or autoimmune disease conditions (eg, relapsing polychondritis) in whom the reconstructed nose is at risk for continuing damage.
- Persons who abuse drugs intranasally and who have not demonstrated at least 12 months of sobriety (Nasal reconstruction is contraindicated in patients who have not definitively demonstrated complete rehabilitation from their substance abuse.).
- Patients who are poor candidates for rhinoplasty in general, including unhealthy patients with poor perioperative risk profile and patients whose ability to follow the postoperative care regimen is limited (ie, patients with severe schizophrenia).
- Patients with unrealistic expectations.
Patients with relative contraindications include the following:
- The patient with multiple previous rhinoplasties who now has scarred-down thin skin (The history of smoking or an unrealistic expectation by such a patient can also serve as reason[s] to delay or dissuade the patient from surgery.).
- Aesthetic rhinoplasty in patients younger than 16 years.
- Patients who are expected by habit or profession (mixed martial artists, boxers) to experience repeated nasal trauma.
What to Do Before Low Nose Bridge Surgery?
- Choose a date that works with your work and leisure schedules. Try not to "squeeze it in." Allow yourself a sufficient "buffer." Recovery period is usually estimated to be 7 to 10 days following surgery. You should be able to resume all usual activities, including intense exercise, within 10 days.
- Receive a list of drugs, both prescription and non-prescription, as well as supplements, that should be avoided.
- Your personal doctor should do a preoperative physical on you. It is not advisable to have it done by a surgeon who is not qualified to assess all elements of your health. Surgeons conduct surgery; internists and family practitioners should be the most knowledgeable about your overall health. Because many of the subjects of his examination have anesthetic and surgical consequences, your surgeon's office should provide you with a document to go to your doctor.
- Before the day of operation, you should schedule a consultation with the anesthesiologist. This is quite important. It is not advisable to meet the anesthesiologist in the holding room, when you may be sedated and unable to clearly communicate. The best method, which is our practice, informs the patient that he or she will get a call from the anesthesiologist no later than 9 p.m. the evening before surgery. If the anesthesiologist has not called by that time, please contact me.
- A preoperative instruction leaflet detailing fundamental preparation difficulties. It should specify which meals should and should not be ingested the night before, as well as when they should be consumed. The preoperative instruction leaflet should inform you what to wear and also include face washing. Please do not bring any jewels or valuables. Also, a caution to avoid taking aspirin before surgery. If you have any pimples or rashes on your nose, you must notify the clinic promptly before surgery since they must be looked out. Pimples are tiny infections, and no elective surgery should ever be performed when an infection is present. There should also be a timeline for recovery and a list of phone numbers to call if you have any questions, ideally including the doctor’s cell phone or home line.
- A final preoperative appointment with the office manager, during which the final written instructions covering all of the items stated above are issued. Consent forms will be filled out. There will be confirmation of the operation time as well as who will be coming to the surgery center for home care education by the recovery area personnel and who will be collecting up the patient after surgery.
What Happens During the Procedure?
Rhinoplasty can be performed in a hospital, an approved office-based surgical facility, or an outpatient clinic by a surgeon. According to the National Health Service (NHS) of the United Kingdom, rhinoplasty might take between 1.5 and 3 hours.
To avoid pain during the rhinoplasty process, an anesthetic is used. Depending on the difficulty of the procedure, a doctor may use local or general anesthesia. If the procedure is uncomplicated, a doctor may inject a local anesthetic into the nose to numb the face. However, if the procedure is more involved, a general anesthesia will be required.
2. The incision
The surgeon may use an open or closed method to do rhinoplasty. A surgeon will cut across the columella, which is the short band of tissue that separates the nostrils, during open rhinoplasty. The open method can be used by a surgeon for those who require significant rebuilding since it gives for better access and sight of the nasal components. A surgeon may do closed rhinoplasty if a person's nasal structures require minor adjustments. The closed rhinoplasty treatment has the benefit of leaving no visible scarring since the physician performs the operation by cutting through the interior of the nose.
3. Reshaping the nose
After the surgeon accesses the nasal structures, depending on the patient’s expectations, they may make any of the following adjustments:
- adjusting the tip, length, width, or ridge of the nose.
- restoring symmetry to the nose.
- correcting a deviated septum.
To do this, the surgeon may remove bone or cartilage. In some cases, the surgeon will add cartilage grafts. They will usually take cartilage from the septum. Less commonly, they will use cartilage from the ear or rib.
4. Closing the incision:
The surgeon will close the incision using a suture, or stitch, and will place a plastic or metal splint on the nose to aid the healing process.
A national survey by the American Board of Cosmetic Surgery (ABCS) suggests that the cost of rhinoplasty ranges from $2,500–$15,995. However, an ASPS statistics report from 2020 noted that the average surgeon fee for rhinoplasty was $5,483.
The cost of rhinoplasty may vary, depending on:
- the surgeon’s fees
- hospital and other facility costs
- medical tests
- prescription medications
- anesthesia fee
- medical insurance coverage
What to Expect During Recovery?
To begin, it's critical to realize that it might take up to a year for the swelling to go down and the final form of your new nose to appear. Most patients will see a modest improvement in look during the first several weeks as the tissues mend and the swelling subsides.
The soft tissues of the nose tend to retain swelling longer than most other areas of the body, so while you may see a noticeable improvement after three to four weeks, your final nose shape may take several months to show.
Most rhinoplasty patients will have their surgery site packed or splinted on the inside, and their nose will be covered in bandages on the outside to preserve and maintain their new nose shape. This dressing is normally left in place for one week before your surgeon removes the dressing and any sutures.
The most noticeable pain and swelling will be in the first week after surgery, and you will most likely have some bruising and discomfort on your cheeks and around your eyes for a week or two, but this will usually recover.
Furthermore, your surgeon will provide you with precise and extensive post-operative instructions. This will cover post-op care, medication regimens, and issues to keep an eye on. Following these instructions will result in the best possible result.
Tips to Reduce Post-Rhinoplasty Swelling
There are some basic common-sense rules about helping nature reduce the swelling after rhinoplasty:
"When can I work out after rhinoplasty?" is one of the most often asked questions. Within the first two weeks after rhinoplasty, modest walking is permitted to manage heart rate and head and nose movement. No strenuous activity is essential during rehabilitation. By week three, you may start working out at half your typical pace. By week four, you should be totally or nearly completely recovered. Lifting weights over the head, as well as full-paced running, should be avoided at this time. After five to six weeks, you should be able to resume your usual fitness routine, including running and weight lifting. If you are unsure about an activity, talk with a surgeon about your recovery status.
Don’t Blow Your Nose
You should not blow your nose for the first 10 days. If you do, the pressure from trying to empty your nose may result in some bleeding and edema. Greater blood will result in more bruising, and the time will restart to reduce the bruise.
Clean The Outside Of Your Nose
Continue to clean around the nose using supplied drugs, such as ointment. We prefer internal or closed rhinoplasty, and because there is no outward incision, there isn't much to do except apply ointment inside the nostrils where the dissolvable stitches reside.
Should I Avoid Eating Food After Rhinoplasty
This is a prevalent myth concerning rhinoplasty. There are no significant limits on foods to avoid following rhinoplasty. While there are some foods that can help speed up healing and minimize swelling, there are no hard and fast rules about what to eat after rhinoplasty.
Many patients who are unsatisfied with the look of their nasal bridge might benefit from bridge rhinoplasty to obtain a more refined, smoothed, and contoured nose. Bridge rhinoplasty is appropriate for those who have depressions or bumps on their bridge.
Candidates should be in good general health, free of major medical disorders such as cardiovascular disease, and have realistic expectations about plastic surgery.