Very bad result of a failed posttraumatic rhinoplasty performed elsewhere on a patient who had sustained a severe nasal and septal fracture in his young years, rhinoplasty during which a over resection of the soft lower dorsum and a total mutilation of the osseous and cartilaginous septum had happened leading to a saddle nose deformity and a sunken lower dorsum associated with a persistent osseous upper hump; either due to the nasal traumatism or as a consequence of the previous surgical repair attempt there were severe damages to the alar cartilages at both the lateral cruras and the domes forming the tip, visible as random and grotesque tip and alae deformities.
The total absence of septum had lead to a total loss of tip support and its collapse, tip droopiness, lack of tip definition, broad nostrils, sunken columella, severely sunken supratip and abnormally large alar flare; on the other hand the excessively long tip was untreated and over the years without septal support it became a Pinoccio's nose deformity.
This was also a hybrid dorsum case in which, simultaneously, do coexist a prominent hump and a sunken saddle nose deformity at the dorsal profile.
It is a matter of highly experienced aesthetic judgment determining what is the right level of a dorsum; such a decision has to take into consideration the tip level, the frontal bone level, the overall facial profile balance and the final nasal size wished or planned.
The same perfect and straight profile can be set at different levels or heights, as long as the radix, the bony dorsum, the cartilaginous middle vault, the supratip and the tip are in the right alignment; deciding what is the adequate alignment line is important in many cases but in those like the one shown here it is extremely difficult to assess and much more to execute technically.
After a thorough reflection it was deemed, evident by the final outcome, necessary applying the principle of the three elevators, one ascending and the other two descending in order to meet at the right level.
On one side there is an excessive hump at the upper dorsum, made up by oversized nasal bones which was aggravated by the multiple fractures happened leading to bone thickening; on the other side there is a sunken profile or saddle nose deformity at the lower half of the dorsum or middle vault, caused by the total absence of the supportive caudal septum making a collapsed supratip; finally, the tip, in this specific case, was deemed excessive in projection, considering the facial balance of this patient and his own personal preferences.
With that said, the right neo level for the dorsal profile is somewhere between the bony hump and the tip as top excess and the sunken middle vault a bottom shortfall; setting the right level at the bony hump and tip would lead to a straight profile by means of massively raising the sunken part so that hump and tip are joined in a straight line, however this would entail an oversized nose; setting the right dorsum at the sunken middle vault would force to perform an aggressive reduction scooping of the nasal bones and deproject the tip, ending in a disproportionately small and flat nose, like some ethnicities; this patient's nose needed both, lowering the upper part of the dorsum plus deprojecting the tip and raising the sunken lower part.
The reconstructive procedure began with open approach, debridement or cleansing of fibrosis and identification of structures; this allowed proper planning and decision making about the grafting strategy.
A large rib cartilage harvesting was the only option to rebuild this nose; once extracted and the donor site carefully closed with layered sutures, the phase of grafts shaping, tailoring and sculpting began, which actually is the most difficult, challenging, creative and somehow artistic part of this procedure.
Two long and firm grafts from the rib were shaped to act as septocolumellar caudal extension grafts to provide nasal length support, act as spreader grafts to repair the middle vault and as dorsal graft to raise the sunken supratip; they were sutured to the remnants of the upper lateral cartilages as stand point.
A septal replacement graft was sutured in between the septocolumellar grafts in a two on one fashion, and at the very lower end of this scaffold a strong columellar strut was assembled to provide the right tip support.
The damages of the alar cartilages could be luckily repaired in a direct form.
The tip was aggressively deprojected by means of trimming a segment of both the lateral and medial cruras of the lower lateral cartilages, reassembled to secure the deprojection; the oversized and split tip and the also bifid columella were managed by cephalic resection of the alar cartilages and scoring of the tip domes plus a posterior transdomal plication of them.
Finally and in view of the transparency of the dorsal work, leading to visible irregularities, a temporalis fascia graft was harvested and applied like a blanket of camouflage leading to a smooth outcome without any trace of irregularities; at the end of the procedure the patient received an alar wedge excision to reduce the flare and the nostrils.
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This information is indicative only and does not represent an obligation with patients or a prediction of forthcoming events, since is based on statistical means for large groups of patients, with the variability that implies, and the biased experience of medical professionals.
Medicine and Surgery are not exact sciences, therefore it is not possible to foretell the most likely evolution neither establish the most suitable management for each individual case until the moment the physicians can preoperatively evaluate the patient and receive feedback about the postoperative.
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All the prices and quotations visible on our website belong to or are calculated out of the reduced price list and do already enjoy by default a -20% discount from the standard price list for our treatments as compensating remuneration for the release and transfer of the intellectual property, the rights of image, the medical records and the personal data of our patients for scientific dissemination, medical teaching, public communication, commercial promotion, advertising marketing, commercial exploitation and disclosure in general, unless they express the opposite at their surgery day booking by opting for the standard prices.
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Our prices are quotations valid for the majority of cases operated on; notwithstanding a few cases are non standard, atypical, requiring exceptional resources and, therefore, needing customized quote calculation; do seek the advice of our Medical and Sales Teams to find out whether your case lies within the standard protocol of management, which actually is the most likely scenario.
Standard quotations do cover the planned protocol of management, including preoperative consultation with the surgeon, preanesthesia examination, basic preoperative tests, surgeon, anesthetist and assistant fees, planned operating room, rental time, regular intraoperative surgical supplies (materials, drugs, etc.), agreed implants (breast, etc.), one recommended postoperative garment (brassiere, corset, etc.), 1 hour recovery unit stay, individual ward room, regular hospital supplies (materials, drugs, etc.) and postoperative office-based care.
Not included in standard quotations are, among others, non basic preoperative tests, pre and postoperative consultant referrals for assessment, additional garments, non hospital supplies (materials, drugs, etc.), postoperative tests and any kind of postoperative re-interventions, postoperative medical or surgical emergencies and costs exceeding the planned protocol of management like unplanned, unforeseeable and unavoidable extended surgical time rental of the operating room, extended hospital stay in standard ward or Intensive Care Unit (ICU) room and all the associated costs with any hospital-based assistance of complications, medicalized repatriation, hostelry accommodation, maintenance and travel costs; we do not take account of any costs not within the scheduled treatment pre and postoperative planned and agreed management.
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Due to the competitiveness scenario of the markets most plastic surgery clinics and plastic surgeons feel forced to invest large sums of money into advertising and marketing campaigns; this non medical additional cost is always and necessarily charged on top of the final price paid by patients, leading thus to an overprice of surgeries and treatments. No one patient wishes to bear that financial burden embedded in the surgical costs, furthermore neither surgeons nor clinics are happy to increase their retail prices and penalize their customers with costs not bringing any kind of special medical benefit, safety enhancements or results improvement; the promotion budget aims only to disseminate the public knowledge of a services provider and raise the awareness about its presence to potential customers, but not to make the service or the product a better one.
Seems like this model is a no-way-out labyrinth from which no one can be freed, furthermore it is such a tempting, easy and hassle-free way that actually most patients and plastic surgery providers are locked into it, happily or with resignation, paying a high price due to being non collaborative; however there is an ideal alternative, based on keeping up a good hard work based on a strive for providing quality service and achieving patients' satisfaction, which necessarily requires the decided support of the clients and somehow their involvement in such virtuous business model grounded on top-notch results
READ ABOUT BENEFITS OF THE COLLABORATIVE MODEL
When plastic surgery providers and patients do actively engage into a collaborative economy scenario a win-win basis is set for their relationship, since the clinics and surgeons obtain the best promotion ever possible with no budget for marketing investment and the patients get in return rid of any additional and unnecessary costs; such a price reduction does not represent any loss in the quality of the treatment they are receiving, furthermore this saving achieved will actually reward customers with a reinforced confidence and guarantee the service providers will strive to perform the best job possible and obtain results second to none.
It is not a paradox or contradiction; under a collaborative economy umbrella plastic surgery patients enjoy a greater plus of confidence that clinics and surgeons will do their very best and beyond to satisfy their customers, in spite the price is lower than in marketing-based non collaborative models; plastic surgery providers who found their business sustainability on the pillars of exclusively or mainly incremental budget investment in ongoing promotion campaigns do have little incentive in achieving first-class results and the best patient experiences, since their business model is not based on returning patients after word-of-mouth dissemination of their reputation but on the attraction of cold clients with sophisticated advertising methods of higher or lesser moral acceptability, attracting customers as parachutists randomly landing on unknown land, which is a perverse business model frequently leading to an unavoidable degradation of safety and results quality besides an uncontrollable increase in costs and prices; this marketing-based model creates no incentives to keep up the good work and pushes the prices higher on and on due to require increasing promotional investments.
On the other side, which is definitely our side, clinics and surgeons who rely solely or mostly their existence and survival in the competitive plastic surgery market enjoying the widespread of their excellence extended by their own patients results and satisfaction, like a mill driven by the winds of prestige, have the strongest ever incentive to be the best service providers around, sourced from the support of happy clients and their operated cases as proof of their excellent jobs; needless to say such supporters, the patients, have to enjoy a share of this benefit so that the incentive is reciprocal; under this scenario clinics and surgeons strive to provide the best service and accordingly patients release and transfer in a fair exchange the materials and tools required to build a marketing-budget-free and virtuous business model which creates the perfect incentives to build the best sponsorship-free reputation, based on the grounds of medical quality thus allowing prices control within affordability thanks to the minimal cost of its maintenance.
This is the deal; patients give in our favor the release and transfer of the intellectual property, the rights of image, the medical records and the personal data of their cases for scientific dissemination, medical teaching, public communication, commercial promotion, advertising marketing, commercial exploitation and disclosure in general, and they receive in exchange a compensating remuneration of a -20% discount from the standard price list for our treatments, as it is publicly visible by default in all the prices and quotations on our website.
As can be observed our visible prices are highly competitive if compared with other plastic surgery providers, actually the difference is approximately a -20% from the average price of each particular treatment in other clinics and surgeons from similar economical areas and countries of comparable development; this is not due to any quality or safety downgrading but to our collaborative business model; in other words, the budget which theoretically should be invested in marketing and promotion campaigns is discounted from the retail prices and, unlike other plastic surgery providers, is not wasted into pointless advertising to patients which entails no kind of added value for them; such campaigns are replaced with our superb results publicized thanks our patients support by letting us use their cases' Before & After and Intraoperative & Technical images and medical details; this explains that price gap between us and other clinics and surgeons.
READ LESS ABOUT BENEFITS OF THE COLLABORATIVE MODEL
Patients gain a highly affordable pricing model with yet world-class standards of medical practice, safety and results, and we gain competitiveness within the industry by means of saving the budget theoretically bound to be wasted in marketing.
Patients contribute with their images and medical details and we compensate them with a -20% discount from the expectable average price quoted by comparable clinics and surgeons.
We receive a boost of unbeatable promotion and market penetration by using our awesome operated cases and the patients enjoy a plus of guarantee that we will strive to conduct ourselves to the highest level of excellence and obtain results better than one can imagine.
We help you access the best plastic surgery results and you help us win the race of the market.
Should you feel not interested in collaborating with our business model and still wish to be our patient? No worries, this perfectly possible under the same philosophy of professionalism, devotion and quality, you have to simply express your opposition at surgery day booking by opting for the standard prices and thus give up the -20% discount of the collaborative model, budget which will be used to promote our business in sponsorships, campaigns or one-time actions aiming to attract new customers who, without your help to take the right decision for their surgery, may need sponsored channels to know about us.
Keep in mind that taking part in our collaborative business model is also an altruist way to help other prospective patients to find the medically right and commercially suitable plastic surgery provider, besides collaborating in the medical education of other surgeons and medical professionals.
We offer a flexible consumer-to-business relationship by letting our patients choose between a release & transfer quotation model in which the standard price list receives a -20% discount becoming thus the reduced price list, and a no disclosure quotation in which the standard price list applies and the patient misses such compensating remuneration.
Two models under the same quality involving different prices and marketing-building strategies; you receive always one guarantee: our commitment we will give you our best.
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