Aesthetic and Functional Rhinoplasty

Review by L M Flood
Middlesborough, UK

This is the third edition of a book that first appeared in 1995. India, we must remember, is the home of reconstructive nasal surgery, but most of the literature has concentrated on the Caucasian (indeed, West Coast) nose. More, recent, work on Afro Caribbean and Oriental patients’ needs has been reviewed in the Journal, but the author stresses the difference in the nose typical of those from the Indian subcontinent.

This is a multi-author work, although Dr Baser is still the main contributor. There is Italian input on nasal surgery in children and our own Guy Kenyon represents the UK, with his experience of nasal obstruction surgery.

The opening chapter, of course, discusses applied anatomy. There is much on the ideal facial proportions for aesthetics, but the text, diagrams and measurements all seem to relate to the young, affluent, White visage. Much of this is inevitably repeated in the final chapter on orthognathic surgery, but this finale does well illustrate just how important a role the maxillofacial surgeon can have in transforming appearance. The second chapter, on psychological issues and counselling, tells us that in India there is a higher proportion of male patients seeking such cosmetic surgery, but reminds us that they can be the higher risk group. I was interested to note that computed tomography is recommended routinely, and I can see, in the crooked nose, how it at least nicely illustrates the challenge faced.

Guy Kenyon has long talked and lectured on the nasal aperture. I was surprised then to read that he doubts the internal nasal valve has any truly ‘valvular’ function. I have always been an otologist, I confess, and his argument is convincing. No, it is the collapsing cartilages of the external valve that drive surgery. This topic is followed by discussions on alar cartilage surgery and spreader grafts, and one of the best descriptions of septoplasty I have ever encountered (I wish I had read this 35 years ago). Figs 4.18(a) and 4.18(c) are both labelled as post-operative. The former might be a disappointing result, but actually looks very different to the successor, so a minor typographical error seems more likely!

Lengthy and very well illustrated chapters on augmentation rhinoplasty, and surgery of the hump and the crooked nose, then follow. I note that in India, the saddle deformity is sometimes taken to suggest leprosy! I started the chapter on hump reduction cynically and the author admits that it is the influence of Western culture that drives the demand for ‘correction’ of what is a normal ethnic appearance. I confess that the results shown were very impressive, reinforcing that I am as guilty as the rest of applying such stereotypes. The Italian chapter on paediatric septal surgery and correction of true external deformity I found particularly novel and of value.

‘Fineness rhinoplasty’, the correction of minor nasal deformities, did trouble me at first. Surgery is now undertaken on patients whom the author would once ‘tend to discourage or refer to the psychiatrist’. The justification is ‘increased awareness and affluence’. In truth, the cases illustrated struck me as less than minor and, again, the results were excellent. This book is not afraid to address complications and revision surgery, and there is a digital video disc illustrating many procedures, with both still slides and video images.

This is a very good review of nasal skeleton and septal surgery. It is lavishly illustrated, and the techniques and assessment would apply to any race. Different skin thicknesses and minor differences in cartilage are less important than the transformation in the economy of the subcontinent, and, with it, the desire for that Californian lifestyle. It is truly remarkable how such surgery can totally transform facial appearance. This is a very impressive book.

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