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George C. Peck, Rhinoplasty: CO2 Laser Offers Advantages Over External Shaving, Aesthetic Surgery Journal, Volume 17, Issue 6, November 1997, Page 415, https://doi.org/10.1016/S1090-820X(97)80062-3
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Among the most frustrating cases in rhinoplasty is one in which the patient does not respond to standard rhinoplasty techniques. Utilizing the closed technique without anesthetic injection or distortion of the nasal tip or dorsum, the surgeon can see the definition and projection of the nasal tip at the time of surgery. Good nasal tip definition with adequate nasal tip projection is the goal and is what will make your rhinoplasty successful. What you see is what you get! The frustration occurs when what you see, you don't like.
Thick sebaceous nasal skin is certainly one of the most frustrating challenges. All of the rhinoplasty techniques to achieve adequate nasal tip definition may not work. Frequently doctors will accept the result as the best that they can do, but this answer is not any consolation to the dissatisfied patient. How many doctors and patients wait years for that persistent edema to resolve and everything to look a lot better? How many Kenalog® injections in the nasal tip and supratip will solve the problem?