The final cosmetic result of a rhinoplasty depends not only on the surgical procedures but on the healing factors of the nasal tissues of the patient. Contractions caused by scars formed over the wounds in the layers of the different tissues (bone, cartilage, muscle, connective tissue) leave their mark on the final configuration of the nose.
One cannot consider the facial skeleton as a stable, rigid and dead formation. Like all other parts of the skeleton, it is constantly subject to structural alterations during the lifetime under the influences of intrinsic and extrinsic stresses. These changes in form and function are greater in the early years and less in the later years of life. "These changing conditions constitute the biologic factor of variability in consequence of which no two living organisms are ever identical in form, structure or function" (Kirk1).
The plasticity of the facial skeleton has been mentioned by
GRIESMAN BL. STRUCTURE OF THE EXTERNAL NOSE: A STUDY FROM THE POINT OF VIEW OF PLASTIC SURGERY. Arch Otolaryngol. 1945;42(2):117–122. doi:10.1001/archotol.1945.00680040153004
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