All about

All about

Nose anatomy

The nose can be divided into exterior and interior. While the outer nose is formed of all those anatomical structures that make up the nasal pyramid and are well appreciated by the observer, the inner nose represents an extremely large and complex anatomical entity that penetrates inside the skull, from the base of the Brain, through the ear (Eustachian tube), up to the eyes and throat.

The outer nose is divided into three parts: the upper or the nasal bones, the intermediate one consisting of triangular cartilages and the lower part with the flap cartilage. The whole is supported by the cartilage septum (movable in the most prominent part to the tip) and bone (from the innermost part to the throat).

The shape of the tip is given from the shape of the flap cartilage and the quality of the skin. The nasal hump may be only bone, bone and cartilage or predominantly cartilage. The inner nose is formed on the mid-wall of the nasal septum, on the outer wall of the swirls and by a series of intercommunicating cavities that are the paranasal sinuses (maxillary, semimascular, ethmoid, sfenoid and frontal). Turbinates are bone structures covered with hypervascular mucosa, which lie within each of the nasal pits. Within normal nasal physiology, they have the indispensable function of conditioning (humidifying, heating and purifying) the air we breathe in order to improve gaseous exchanges.

When there is alteration of the septum or valve or allergic phenomena, the lower turbinates hypertrophied in all three of their anatomical components which are the bone (lower crown), cavernous tissue and mucous membranes, preventing normal respiration.

Nasal aesthetic surgery

Functional recovery of the nose can not be separated from the morphological and aesthetic part. Those who want and require aesthetic corrective action should keep in mind that a reduction in the size of the external nose may result in a reduction in functionality due to the alteration of balance between the internal nose and the external nose. Any preexisting anatomic alterations (septic, valvular, and turbinate) that have gone unnoticed may occur after aesthetic intervention, thus creating a functional deficit.

All this has to be avoided and this is why it is necessary and indispensable to treat the nose in every aspect. Therefore, to achieve a natural aesthetic result, it is compulsory to work harmoniously on all the anatomical parts of the external nose. You will then have to reduce some anatomical parts of the internal nose to maintain that balance between the inside and outside and between the shape and function necessary and indispensable for good breathing.

But how do you define a nice nose? Once the intervention has been projected, it is executed. The result will have to be a nose with the indispensable requirement of naturalness. The nose is natural and does not show the typical stigma of rhinoplasty when the dimensional relationship between tip and back is optimal, respecting the normal values ​​of the angles that the nose forms with the forehead and upper lip.

When a patient requires to file out the back he does not know he is asking for a worsening intervention. A solid structure, in fact, if it is lowered, it exhibits an optical effect as its elongation and therefore a loss of naturalness. The nose is like a big puzzle: if only one piece is shrunk, all the others will move, creating asymmetry and disorientation. It is therefore very important that remodeling involves all the joints in a harmonious manner (like in the use of a pantograph) and must always be in the respect of a global vision of the face and nose.

Nasal functional surgery

Painless surgery and without endonasal swabs: these are the foundations of the innovative surgical technique MIT, conceived in 1997 by Professor Gottarelli, who cures patients suffering from hypertrophy of the turbinates, a problem that can cause various pathologies of the respiratory tract and serious complications. The MIT, a seven-move microsurgical surgery in seven minutes per part, does not use hot techniques (lasers, radio frequencies, electrosurgents) that always lead to relapse.

For proper breathing it is necessary not only that the turbinates have the right size but also that the nasal septum is in the axis and the nasal valve works best. These three anatomical structures are fundamental for good breathing.

Complex septum deviation and reconstruction, modification or enlargement of the nasal valve are treated by Professor Gottarelli with the method of structural rhinoplasty. A weak nasal septum or a narrow nasal valve will then be sustained through particular and small cartilage supports taken from the patient’s septum cartilage. The successful outcome of an intervention, which definitively resolves sinusitis and polyposis, is derived from the rhinoplasty or rhinoplasty implementation methodology that is based on the precise integrated application of multiple techniques. Otherwise, there will be pain, relapse, and dissatisfaction of the patient.

Turbinates surgery

Lower turbinates are dynamic structures that have the task of diverting the nasal airflow and creating a first front of resistance to give way to the bloodstream that acts like “air conditioning” for the air coming from outside before entering the lungs. They are covered with mucous membranes and arranged to form a series of folds (nasal cones) that increase the contact surface between the nasal cavity rich in blood vessels and the inhaled air, which is then quickly heated and humidified.

They are rather voluminous structures (4-7 cm in length for about 2 cm in width) located in the critical area of ​​the nasal valve near the septum in its intermediate portion, consisting of trabecular bone tissue, sprayed by a dense capillary bloodstream, And covered with mucus-cavernous tissue.

Examination of the nose through the endoscopic probe is able to highlight the size, morphology and color of the lower turbinates, in addition to the pathophysiological features of the nasal mucosa and mucous secretion. The administration of a vasoconstrictor is able to confirm the diagnosis of vasomotor rhinitis and to validate any possible use of MIT or turbinoplasty, the technique of Professor Gottarelli, which reduces the volume of inferior hypertrophic turbinates in all their anatomical components.

The indication of lower turbinate surgical treatment by MIT is recommended in patients with unilateral compensatory hypertrophy associated with nasal septal hypertrophy and in patients with chronic bilateral hypertrophy.

Nasal reconstruction

The way with which Paolo Gottarelli, who has been passionate and enthusiastic for over thirty years, is concerned with nasal reconstruction, is the absolute search for quality. Objective pursued with the development of the MIT technique, which represents the most comprehensive approach to resizing the lower turbinate in compliance with its function.

The association of this method to the structural rhinoplasty of Dean Toriumi and J. Tebbetts‘s vector rhinoplasty led to a new approach to nose surgery: global rhinoplasty (functional and aesthetic), which makes it possible to obtain the result of reducing not only the risk of haemorrhage in the postoperative, completely eliminating the use of dreaded nasal swabs, but also improving the patient’s quality of life after surgery.

A nose reconstruction method that combines the clinical needs of the disease with the aesthetic needs of the patient with a level of satisfaction never achieved before.

Nasal septum deviation

With the first colds, or in the spring, with the arrival of allergies, nasal congestion is on the agenda. An already compromised respiratory condition, often due to a diverted nasal septum, can accentuate the symptoms.
A nose that has undergone these problems does not work properly.
According to a study carried out by Paolo Gottarelli’s Rhinoplasty Observatory, frequent colds have a deeper cause, they’re a nasal septum deviation, often unrecognized. According to the study, in fact, 80% of patients are unaware of the problem, perhaps congenital or due to an accident that has happened many years ago, possibly during childhood. The first consequence of the sifting of the septum is an increase in the lower turbinates, anatomical structures found within each of the nasal cavities, with the function of humidifying, heating and purifying the air we breathe, which by increasing too much the volume makes it difficult breathing.

The solution to this problem comes from microsurgery, with an intervention able to cure the nose and restore the correct passage of the air, thus avoiding having often the nose closed. Thanks to the functional rhinoplasty performed with the MIT technique, conceived by Gottarelli already in 1997, it is possible to say goodbye to frequent nasal congestion. The intervention consists of only seven seven-minute nasal cavity movements without the use of hot techniques (lasers, radio frequencies, electrosurgents) that always lead to relapse. The purpose of the intervention is to reduce the volume of hypertrophic turbinates and create more room for the inspired air passage.

It will then go to the nasal septum, with surgery without any postoperative pain and without the use of annoying nasal swabs. A TAC prior to surgery is the fundamental test to provide all the information about any anatomical alterations not only of the nose (septum, turbinates) but also of the paranasal sinuses (sinusitis, polyposis, occlusion of osteoarthritis, osteoarthritis, etc.) Following the operation, performed in general anesthesia, which lasts for an average of 30 to 90 minutes depending on the type and number of corrections to be made, the patient will carry plasters on the back of the nose And a small plastic splint for 7 days. Work can resume from the third day.

Rhinoplasty cost

When it comes to cost, the question arises almost spontaneously: why a professional’s performance is termed “expensive” with respect to another without questioning and questioning what is “bought”? In the case of nasal surgery, only the removal of a hump on the back, a cobbler combined with the remodeling of the tip, or the correction of a deviated nasal septum and the size of the turbinate, often too large to allow breathing? It is quite clear that there is no slight comparison.

All this without counting professionalism, professional curriculum vitae and the number of surgical procedures performed, an indisputable index of reliability and more predictable results of the intervention.
In this case, it is not a matter of paying “something” more on the basis of a brand more or less luxurious, but to give the right value to different procedures and performances, moreover with more casework.

This is what everyone who wants to undergo a nose surgery should ask.
As for the aesthetic approach to rhinoplasty, it should also be remembered that Professor Gottarelli’s method involves designing, along with the patient, the changes to be made to the face and, specifically, to the nose or chin. There is no doubt that the most secure, modern, and effective method is to involve the patient directly in the manipulation of their own change by using a photo editing program on the computer monitor.
Why use a photo editing program like Photoshop is safer than using sophisticated image manipulation programs? The answer is quite simple and concerns only the professional fairness of the surgeon, who does not have to create in the patient excessive expectations that would only be helpful to acquiring the consent to the intervention according to more commercial and deontological methods.

If, in fact, a patient’s 95% improvement is achieved and 96% is achieved, you will have a happy and satisfied patient. If you promised 99% to 98%, that result would be seen as a failure.
That is why Professor Gottarelli prefers to be somewhat cautious in the use of sophisticated imaging techniques that on the one hand are indispensable for the design of the intervention and therefore also for its execution, but which on the other hand present risks that absolutely must be avoided.

It is therefore clear that the way with which Paolo Gottarelli, who with passion and enthusiasm for over thirty years is concerned with nasal surgery, is the absolute search for quality. The objective pursued by the development of MIT technique, which is without doubt the most complete approach to resizing the lower turbinate in compliance with its function.

The association of this method to the structural rhinoplasty of Dean Toriumi and J. Tebbetts’s vector rhinoplasty has led to a new approach to nose surgery: global rhinoplasty (functional and aesthetic), which results in the reduction not only of the risk of haemorrhage in the postoperative, completely eliminating the use of dreaded nasal swabs, but also improving the patient’s quality of life after surgery.
A method that, after all, succeeds in combining the clinical needs of the disease with the aesthetic needs of the patient with a level of satisfaction never achieved before.

Ask for a consultation