beyond BMC centers

Rhinoplasty Bizrah: Septorhinoplasty Incisions and Primary Manoeuvres: Primary Manoeuvres


– Dorsum undermining. – Division of upper lateral cartilages from septum. – Caudal trimming of upper lateral cartilages. – Conservative trimming of the caudal septum. Dorsum undermining: Following the intercartilagenous incision: Use a sharp scissors to identify the right plane of the caudal upper lateral cartilages. Next, use blunt scissors to proceed with skin...

Rhinoplasty Bizrah: Septorhinoplasty Incisions and Primary Manoeuvres


Incisions are essential in order to approach, reach modify and correct the nasal structure in septorhinoplasty. The septorhinoplasty incisions have a special importance. The intercartilagenous incisions divide the attachment of lateral crus to the upper lateral cartilage and the transfixion incision divides the attachment of the medial crura to the caudal septum. This results in loss of tip...

Rhinoplasty Bizrah: Local Anaesthesia


Rhinoplastic surgeons have a duty to dispel the horror stories that have become associated with nasal surgery and general anaesthesia. We were urged to apply and develop the technique of local anaesthesia with sedation, in order to reduce the patient’s fear caused by general anaesthesia and to provide a more safe, comfortable and convenient procedure. The application of local anaesthesia with...

Rhinoplasty Bizrah: Rhinoplasty Patient Management: Follow-up


The first follow-up visit will be one week postoperative for cast removal. When removing the cast consider the following: Reassure the patient that there is no pain. Remove both sides of the tape at the same time and the cast from the middle. Do not remove side by side, the cast will cause pressure and bump the nose. Clean the nose with soapy wet tissue (Chubs wet pack). Remove...

Rhinoplasty Bizrah: Rhinoplasty Patient Management: facts


The following facts should be made clear prior to surgery: The aim of the operation is improvement and not perfection. The patient should not have realistic expectations. There is always the possibility of minor revision procedures two to six months postoperative. Factors that might affect the outcome and are out of the surgeon`s control:Infection, scarring, keloid, wound contracture,...

Rhinoplasty Bizrah: Rhinoplasty Patient Management: Preoperative Investigation


Preoperative Instruction The following investigations are routinely performed to check the general health of the patient: CBC, RBS, Creatinine, Liver function test, Hepatitis, HIV. ECG and Chest x-ray. CT scan of nose as sinuses: if patient is going for both functional and cosmetic surgery.   Preoperative Instruction Referral form is given to the patient for the hospital...

Rhinoplasty Bizrah: Rhinoplasty Patient Management: In-patient Management


Preoperative preparation Anaesthesia and sedation Immediate postoperative care Preoperative preparation of the patient Patient is admitted to the day case surgical center or to the hospital at 7 a.m. Patient receives clinical examination by the admitting doctor and nurse. Patient with his preoperative investigations reviewed by the anaesthetist at 8:30 a.m. ...

Rhinoplasty Bizrah: Rhinoplasty Patient Management: Postoperative instructions and follow-up


The following postoperative instructions are given to the patient on discharge from the hospital. The first ten instructions are carefully read by our staff nurse: Take your antibiotics regularly as indicated. Do not expose yourself to any visitors with common colds or infections. Stay at home for five days to avoid dust and contamination of the nose by the outdoor atmosphere. ...

Rhinoplasty Bizrah: Rhinoplasty Patient Management


An outstanding corrective surgical plan needs to be based on thorough clinical assessment, clear doctor patient communication and frank discussion of the pros and cons of surgery. In addition, a well informed consent, smooth in-patient care and close follow-up are mandatory in order to lessen the patients fear and anxiety, limit complications and cut down the medicolegal cases. Practical...

Rhinoplasty Bizrah: History of Facial Plastic Surgery: Moving into Facial Plastics


An ENT, head and neck surgeon who is familiar with parotid surgery, should not find a facelift difficult. Also, one who has practised osteoplastic frontal flap operations would find forehead lifting a relatively easy task. Therefore, it is a natural progression for otolaryngologists, once they have mastered rhinoplasty to move on to other parts of the face. Ira Tresley, MD, President,...