This is one of the most tricky and weird ethnic rhinoplasty and structure rhinoplasty cases that can be met in the field of high difficulty nose surgery, due to the mixed blood features of a patient with Asian, Hispanic, Arabic, Jewish and Andine features at the same time, all manifested in her nasal anatomy with specific issues; furthermore the patient expressly requested a very natural nose which would look totally proportionate to her overall facial balance.
This nose is tricky because at first or lay glance one might say there is a long hump needing removal so that the tip of the nose and the radix would form a straight profile line; that would be a dramatic error of judgment, since doing so the nasal pyramid would barely exist and the nose would end flat and fully Asian; furthermore such a tiny nose would not fit at all with the broad craniofacial skeleton of this patient's face, the large cheekbones, forehead, etc.
The real hump excess was minimal, but was virtually aggravated due to the Asian features of the patient visible in her tiny tip; the nasal tip was short, sharp, underprojected and as happens in most Hispanic and Andine noses was also poorly supported due to partial absence of a very short caudal septum.
Such short caudal septum made also the nasolabial angle too wide and the tip upturned, plus a short nose syndrome.
We are not talking about a slightly or moderately short tip, it is a matter of a large amount of millimeters the tip had to be lengthened and quite ones the nose lengthened which equals to derotate and lower the tip; the former connects with another peculiar issue, the patient suffered from short columella syndrome, this means the skin at the columella was in massive shortfall and did not allow the grade of tip lengthening that was required to restore normal facial proportions; this is the reason why a columella lengthening flap had to be done instead the traditional open approach incision, so that a supply of cutaneous length would make viable the skeletal lengthening which was accordingly planned; note the atypical columellar incision for the advancement skin flap, which recruited skin from the nostrils towards the midline.
To summarize, we have a short nose syndrome, a short tip syndrome, a short columella syndrome and an apparently large and long hump which actually is a very short and thin one; but there were more issues.
A typically Arabic feature is the noticeable inversion or concavity of the lateral cruras of the lower lateral cartilages, which was bilateral, total, symmetrical and very deep; note how the nostril rims were collapsed and the tip was excessively sharp due to this fact.
Due to the short tip and the short caudal septum there was a sunken supratip which required a raise with grafting; actually this case could be flagged also as tension nose deformity, due to having a relative excess of pyramidal structures and a shortfall of tip and soft parts, which for real was a massive shortfall of the lower part of the nose and a lesser but still severe shortfall of the pyramidal parts, with only a subtle dorsal real excess.
As minor features it is to mention the slight and atypical concavity of the upper lateral or triangular cartilages and the supratip pinching.
Last but not least, the dorsal hump and the humpless dorsum had a rhomboid configuration, requiring paramedial resection of the lower synchondrosis and the upper synostosis between the nasal wall and the, respectively, soft and hard nasal septum.
All the former issues are not atypical or weird themselves, actually all of them are very typical from different ethnicities; what is a real oddity and a technical ordeal is facing them all together in the same nose.
Deeming the nose disproportionately small in massive grade if considered within this particular patient's face, the surgical plan was a full augmentative rhinoplasty at all areas except two; the only reduced parts were the real hump arising after the nasal augmentation and the broad dorsal rhombus which required narrowing as mentioned before.
The comprehensive augmentative rhinoplasty began harvesting the maximum availability from the donor ears' concha bowls, which fortunately had cartilages large and thick enough for the purpose, therefore preventing the use of rib cartilage.
Once the dorsal work and the mandatory osteotomies were performed the grafting phase began, applying onlay grafts on top of the naturally existing skeleton which was used as underlying platform; a pair of onlay grafts were applied riding the original lateral cruras and in practical terms replacing their aesthetic effect, enlarging the alae, correcting the lateral crura concavity and treating the alar rim collapse.
A supratip graft was applied to correct the sunken middle vault; then a highly customized and augmentative tip graft was applied on top of the original tip domes, very finely tailored and scored as grid on its outer surface to achieve a rounded effect; a columellar onlay graft made the caudal extension effect in a indirect manner and provided the nasolabial angle reduction.
The thin dorsal skin allowed multiple transparencies of the heterogeneous dorsal work, since each dorsal part had received a different technique due to be featured by different issues, so it was decided to apply a superficial temporalis fascia all over the dorsum and nasal walls, from radix down to the supratip, in order to provide the right camouflage; this was a successful solution as can be noted in the postoperative smooth dorsal contour; this temporal fascia graft also allowed correction and hiding to the concavity of the upper lateral cartilages and the pinched middle vault.
Augmentative rhinoplasties are way more difficult, challenging and complex than reduction ones; should the patient have mixed and atypical features this escalates to a superior level; this patient enjoys now of a larger, proportionate and suitable nose within her now balanced facial features.
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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.
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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.
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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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