Micro-saw assisted Rhinoplasty

The world of rhinoplasty is going to live a break-through in its history. The power of hammer for breaking the nose is at the end of its way. Technology is going to equip the aesthetic surgeons to cut the nose structure with ultra micro motor systems. Micro saws, micro rasps, and endoscopic facilities, all will be the new armamentarium of aesthetic surgeons to do perfect rhinoplasties.

Dr. Yakup Avsar from Istanbul has developed a technique for cutting the nasal bones. His article with the name of ‘Nasal Hump Reduction with Powered Micro Saw Osteotomy’ was published at the first number of Aesthetic Surgery Journal (Official journal of American academy of aesthetic plastic surgeons) on January 2009. In this article Dr. Avsar discusses the advantages of nasal hump removal with powered micro saw technology.

This technique prevents the risk of bone destruction that may be occurred with breaking by the power of hammer. The fine micro motor cutting technology of Bien-Air Company (Switzerland) is used for this technique. Ultra micro saws and rasps reshapes the fine bony structure of the nose in its most precise form. Of course for big humps it is not enough by itself to rasp the bone, instead it is necessary to cut the hump step by step to reach the ideal plane and then rasp the bony edges to smooth it. The fine arrangement of micro saws is also used to mobilize the lateral nasal walls to make the wide noses more narrow.

Dr. Avsar denotes that the control of cutting in micro motor technology is completely in the hands of aesthetic surgeon without relying on the assistant to input the power of hammer. Also the direction of osteotomy is easily controlled in this system more better than controlling the hammer power.

The most advantageous side of this technology is its capability in designing the nose. The aesthetic surgeon designs the ideal nose for your face in computer and plan to do the surgery based on the difference between the two. With this micro technology the aesthetic surgeon will be able to strictly define the enough tissue that should be removed from the bone structure of the nose.

One of the most important poits in rhinoplasty is the ability of aesthetic surgeon in assessing the result of surgery during the operation. For this there should be no swelling in tissues. In this technology, the skin cover of the nose is protected from swelling with the aid of retractors especially during the rasping. From the other hand the surgeon sees and views all the steps of bone surgery under direct vision and also under endoscopic control.
So the risk of surprise prominences is deeply decreased when the swelling sets back after surgery.

Another advantage of surgical micro motor system is the ability to do all of the stages of bone surgery under direct irrigation cooling and this protect the tissues from heating and destruction. Irrigation complex of this system enables the plastic surgeon to lower the heat especially during rasping that may destruct the tissues and cause swelling.

In this method computerized designing is done based on the ideal nose configuration.
Access to the nasal structure is provided with no-scar appraoch. The aim is to change the nose shape and provide harmony between the nasal segments and also face compartments. Septum surgery is the cornerstone in aesthetic nose surgery and airway refinement is achieved by right instrumentation in the form of septo-rhinoplasty.

Micro-dissection of micro-rhinoplasty procedure provides less invasive manipulation that by itself results in fast healing postoperatively with minimal bruising and edema formation.

The most characteristic part of micro-rhinoplasty is the use of ultra-micro-motor system in the shaping of nasal bone compartment. It is not used the hammer power that is destructive in reduction of bony hump. In stead of that, Dr. Yakup Avsar uses the more delicate and controlable power of micro-saws and micro-rasps that enables him in sculpting the details of nasal bones. This technology decreases the risk of nasal bone destruction and also the complications of hump fracturing that is common in usual rhinoplasty procedure. For this after micro-rhinoplasty the probability of re-operation decreases very strict.

Micro-refinement of cartilaginous compartments of nose is another part of micro-rhinoplasty that facilitate the shaping procedure and also symmetry is achieved in its most delicate form.

Postoperative period after micro-rhinoplasty is characterized by minimal pain, minimal discomfort and fast healing is the definitive characteristic of the procedure.

Question:
What is the duration of operation in micro rhinoplasty ?

Answer:
The duration in micro rhinoplasty is between 2 - 2.5 hours. This time duration for tip surgery is about 1 hour. For septorhinoplasty this time is somewhat more and changes between 2.5 and 3.5 hours.

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Question:
For whom is micro rhinoplasty is suitable?

Answer:
In females after 18 years and in males after 19 years the micro rhinoplasty can be performed successfully. In patients with perevious unsuccessfull rhinoplasties this operation is the ideal form of surgery.
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Question:
My nose skin is very thin. What type of advantages micro rhinoplasty brings in this case?

Answer:
In patients with thin nose skin, even the slightest irregularity can be felt or even seen. These irregularities can occur in bony or cartilage compartments. In usual rhinoplasties done with routine osteotomes and rasps, bony irregularities may be seen because of inadequate control of the surgical instruments. The instruments may fracture the bone in undesirable way. This is not the case with powered micro osteotomy that cuts the bone under direct control. Fine results of micro osteotomy do not cause any irregularity visible or palpable through the thin skin. Also fine shaping of cartilage structures of the nose with preparation of cartilage micrografts if it is needed helps in preparing smooth cartilaginous compartment.

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Question:
What is the advantage of micro rhinoplasty in elderly?

Answer:
After 45-50 the bones become looser and more brittle against trauma, so the power of hammer becomes more destructive in these patients. Micro saw system brings a lot advantages for these patients by preventing the unwanted destructive results on bone.

Nose

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Question:

I am 24 years old and I had 2 unsuccessful rhinoplasties before. I want to have the last operation. Is it useful for me the micro rhinoplasty?

Answer:
I do many secondary rhinoplasties with professional endonasal system even ig they have had their previous rhinoplasties with open approach. Also micro saw system brings the capability to do every minor and major remodeling on bone. I harvest the remnants of septal cartilage in most of my cases with micro dissection from inside the nose so the need for cartilage from ear or ribs decreases very distinct. The most important matter in secondary rhinoplasties is the quality of skin and if there is not problem in this case, many can be given to the patient by micro rhinoplasty.