wasperformed FacialSurgery.com
Steven M. Denenberg, M.D.
Steven M. Denenberg, M.D.

Rhinoplasty tutorial >> Incisions >> page 2
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We don't start with the external incision, but rather with one of the internal incisions.  The pictures above demonstrate making the first incision.  The left image above shows initiating, and the right image completing, that opening incision, which we call the medial marginal incision.  A standard scalpel is used throughout the operation.  With my left hand, I'm twisting the tip of the patient's nose to her left, to stabilize the nose and expose the place where I'd like to cut.

Most of the intra-operative pictures that you'll see on this site were taken from the perspective of where a right-handed surgeon stands: to the patient's right, about at chest level, with the patient's head elevated slightly on the operating bed.

Click on any image in this tutorial to see a greatly-enlarged version
Now I make the lateral part of the marginal incision.  The incision is called "marginal" because it follows the margin of the nasal cartilage that gives the tip of the nose its shape.  The image above right shows the position of that cartilage in blue, and I'm trying to hug its lower edge with the scalpel.  You'll see the entire cartilage as soon as we finish the incisions.

In medical lingo, "lateral" means "away from the middle," so this is the lateral part of the incision.  The "medial" part of the incision, the part "closer to the middle," is the incision that hugged the side of the columella, pictured at the top of this page.

Clear all red checks in the Rhinoplasty Tutorial

All surgery depicted in this essay, except where noted, was performed by Dr. Denenberg