Younique Rhinoplasty

A cutting-edge surgery

Definition of the objectives. Study of the details. Selection from a rich repertoire of surgical techniques. The right surgery in the right place, never unnecessarily invasive. Ability to adapt the procedure to the person and not vice versa.
The nose is an inborn airway, a sign, and a symbol of life. It is a sensory organ that reacts to fear, threat, and pleasure. The seat of smell, a primordial sense, the nose is the cornerstone of sexual identity, the paradigm of form and function. These are the reasons why rhinoplasty occupies the highest level of facial surgery.
The operation of rhinoplasty (correction of the external nose) or septorhinoplasty (combined correction of the external and internal nose) aims at fixing structural alterations of the nose, responsible for irregular shapes and/or functions. Surgery will probably fail if not preceded by an accurate anatomical-functional diagnosis, a sophisticated aesthetic analysis of the external nose, and a deep understanding of the psychological and motivational state of the person who entrusted the surgeon with his or her face.

Pietro Palma

Rhinoplasty international expert

International Rhinoplasty Specialist

My philosophy is simple. An approach based on thorough, sincere passion is the only way to the mastering of an art. The same is valid for rhinoplasty, which we can consider a form of surgical art. Through complete and exclusive dedication, the surgeon can penetrate the depth of this surgical specialty, govern its complexity, grasp its nuances, anticipate the result…

Take a closer look…

Rhinoplasty

Rhinoplasty: surgical correction of the appearance and/or functions of the nose

Rhinoplasty is a facial plastic surgical operation that aims to remodel the shape and/or size of the external nose thereby achieving a more balanced and symmetrical appearance of the nasal pyramid. Along with correcting the appearance of a nose, rhinoplasty can also improve its function by addressing obstructed airflow.

  • A Septoplasty is the correction of a deviated nasal septum, essentially aiming at improving nasal function.
  • A Septorhinoplasty (also, rhinoseptoplasty) is the combined correction of the external and internal nose.
  • The turbinates are internal nasal valves that heat, purify, humidify, and regulate the airflow. Surgery that involves the turbinates is defined as rhino-septo-turbinoplasty.

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Nasal valves (internal and external) are critical structures acting as air-flow limiting segments. Their anatomy and functional status must be thoroughly evaluated before surgery. Specific surgical attention is to be given to these paramount functional areas in primary cases. Reconstruction of internal and/or external nasal valve area (nasal valve surgery) is frequently undertaken during secondary rhinoplasty or revision rhinoplasty.

Given these premises, the term rhinoplasty should indicate the correction of the external nose only. However, even when the patient asks for a “nose job” to beautify his or her look, correcting the dorsum, tip, and nasal alae will inevitably have a functional impact on the internal nose.

Nature does not separate form from function. They are the two sides of the same coin. An exclusively cosmetic approach to rhinoplasty is not only technically inadequate but also anatomically inappropriate as entails risks of adversely affecting form and function of the nose.

Pietro Palma, leading expert in rhinoplasty in Italy and abroad, performs rhinoplasty in Milan at Clinica del Viso and Casa di Cura “La Madonnina”.

Nose surgery with the super-specialists

Currently, an increasing number of rhinoplasty specialists tend to use minimally invasive techniques in order to reduce untoward side effects and complications of surgery. Focusing on well-defined anatomical targets while adopting reversible technique represents the safest and most efficient way to maximize rhinoplasty results.

Rhinoplasty is a highly creative operation. However, shortcuts, approximations or improvisations are unacceptable for such a sophisticated surgery that deals with millimeters of change. There is no “magic formula for a perfect nose.” The surgeon can maximize the success rate only being systematic and meticulous in all the phases of the process: functional assessment, photo-analysis and morphing with dedicated software and, above all, an exclusive surgical super-specialization are indispensable prerequisites to rhinoplasty.

In opposition to the “generalist” surgeon, the expert in primary or secondary (revision) rhinoplasty has acquired specific and superior skills through many years of dedication to nasal surgery. Whether the surgical correction concerns the tip, the dorsum (nasal hump), the deviated septum, the valves or the turbinates, the surgeon must possess specific technical competences as well as sound surgical experience to tackle with all necessary proficiency the countless anatomical variants to be corrected. Balancing the different sub-units of the nose and functionally re-contouring the internal nose should be systematically pursued in primary, and unquestionably, in the more demanding secondary rhinoplasty.

Nasal tip rhinoplasty: surgical sculpturing of the tip of the nose

The appearance of the nasal tip is determined by two main components: the cartilaginous framework (i.e., shape, size, and firmness of the alar cartilages) and the external skin-soft tissues envelope. The tip confers harmony to both the frontal and profile views. A nose with an inadequately projected, drooping, amorphous, “boxy” or asymmetrical tip would greatly benefit from targeted tip surgery. The aesthetic value of nasal tip rhinoplasty can have substantial implications for nasal function. Altering nasal tip structure can significantly improve nose aesthetics but requires thorough planning and precise execution in order to prevent breathing disturbances due to an excessive weakening of the cartilaginous framework that may lead into the collapse of the alar cartilages with severe consequences on breathing, especially during inspiration.

In “nose tip plasty”, aesthetical harmony is achieved by subtly balancing the various anatomical components: the volume of the tip must be corrected so to be in an aesthetical relation with the width of the nasal bridge, and the domes must be well-defined without unnatural narrowing or “pinching”. The surgeon must create symmetric nostrils borders, elegant contours of the alae, a correct amount of columellar show, and a graceful transition between alae and cheeks. The columella must be as close to the midline as possible, with an elegant transition to the upper lip. Excessive skin thickness can be improved through selective “defatting” procedures. Finally, releasing some muscular components of the tip can correct excessive tip dynamics (“The tip moves or falls when I speak or laugh”).

Hump ​​rhinoplasty: removal of the nasal hump or humpectomy

The “rhinoplasty of the hump” (technically, humpectomy) becomes a profiloplasty in the hands of the specialist. The harmony of facial features depends on several interconnected factors. Confining surgical manoeuvers to the hump could have a detrimental effect on the harmony of the whole. Moreover, the visual perception of dorsal hump may be accentuated by the lack of tip projection/rotation and the position of the root. Also, the shape of the forehead and the position/volume of the chin have a significant influence on the visual perception of the dorsal height.

The proper aesthetical repositioning of root, dorsum, and tip of the nose foreshadow an elegant recontouring of the nasal profile as a whole, consistent with the modern principle of nasal profiloplasty as opposed to the more simplistic humpectomy.

The specialist rhinoplasty surgeon is aware of the implications that the removal of the hump can have on functional aspects, therefore he or she must carefully evaluate the relationship between internal and external structure of the nose.

Any lowering of the dorsum implies a reduction of the inner nose, and consequently of the air volume it can contain. This is akin to reducing the height of a room by lowering the ceiling. Considering that in over 70% of primary rhinoplasty the patients request a reduction of the nasal size (“Doctor, give me a smaller nose, please!”), the surgeon must be prepared to tackle the potential breathing problems caused by a deviatedseptum, narrow valve areas or hypertrophic turbinates that may be clinically silent in a larger nose.

The hump is indeed frequently associated with deviations of the septum/pyramid, or hypertrophy of the inferior turbinates. The latter are internal valves containing vascular spongy tissue that tend to gradually expandin the cavity opposite to the deviation. Therefore, the repositioning of the septum (septoplasty) together with a simultaneous turbinoplasty may prevent post-operative nasal obstruction.

Humpectomy can also create problems to the size and stability of the internal nasal valve. Specific procedures must be carried out in order to prevent valve problems that may significantly impair nasal breathing, especially during the inspiratory phase. Specific shapes of the nasal pyramid like the tension nose (large nose with high, overprojected and narrow dorsum) are at risks for internal nasal valve problems. Similarly, specific configurations of the alar cartilages like the cephalic malposition of the alar cartilages requires utmost surgical attention in order to avoid functional derangements of the external valve area.

Thus, during a humpectomy the surgeon cannot ignore an accurate assessment of the internal nose, and a possible correction of anatomical anomalies of the inner nose (septoplasty, turbinoplasty or valveplasty). Once again, form and function cannot be separated in nasal plastic surgery.

Septoplasty: surgical correction of the deviated septum

The nasal septum is the boney-cartilaginous wall that separates the nasal cavities. In addition to playing a crucial role in the respiratory system and in immunological defense against airborne infections, the septum also has a well-defined structural function. The configuration of the septum does crucially contribute to determine shape, size, length and projection of the external nose. An inadequate or aggressive approach to septoplasty, especially when it does not include rhinoplasty, can cause saddling of the dorsum and/or the drooping of the tip.

Though never perfectly straight, position and shape of the septum can be altered by developmental or traumatic causes. Nasal septum deviations can be asymptomatic or associated with breathing difficulties. Other nasal symptoms are related to a deviated nasal septum, like crusting, dryness, nose bleeding, and sleep breathing disorders such as snoring and obstructive sleep apnea syndrome. When the regular inflow and outflow of air during sports, sleep, or waking hours is jeopardized by a deflected or displaced septum, a surgical correction may be indicated.

The surgical correction of the deviated septum is called septoplasty (septorhinoplasty when combined with the modification of the external nose). The procedure aims at repositioning the septum on the midline thus improving nasal breathing. In septorhinoplasty, along with the correction of the septum, the procedure also includes the modification of the anatomical elements responsible for the altered shape of the external nose. Excessive nasal length, over-projection of the dorsum, inadequate rotation/projection of the tip, columellar deviations, and nostril asymmetry are the most common.

Septorhinoplasty: surgical correction of the external and internal nose

If by rhinoplasty we mean a correction of only the external nose, the combined correction of the external and internal nose is better described by the term septo-rhinoplasty (or rhino-septoplasty).

Alongside the classic techniques widely illustrated in medical literature (external or open rhinoplasty and endonasal or closed rhinoplasty), septorhinoplasty is compatible with the Hybrid Rhinoplasty™ invented by Pietro Palma. The “made to measure” incisions, exposure and surgical manoeuvers minimize the risk of complications due to incomplete or excessive surgery including overgrafting and oversuturing procedures, avoid potentially visible scars of the columella (albeit infrequent in expert hands) and maximize the accuracy of the results on the targeted anatomical areas.

Revision rhinoplasty: surgical correction of unsatisfactory results

We distinguish primary rhinoplasty (the first operation) from secondary, tertiary, quaternary rhinoplasty, required when the patient is dissatisfied with the functional and/or aesthetic result of previous operation(s). The accuracy and millimetric precision required by primary rhinoplasty make it the most challenging facial plastic surgery procedure. Even more than primary surgery, revisions of rhinoplasty demands sound theoretical knowledge and advanced operative skills.

The secondary rhinoplasty surgeon must operate with the utmost precision, and possess operative versatility and surgical maturity at the highest level. The specialist revision rhinoplasty surgeon has to make consistent decisions throughout the whole therapeutic process, from the creation of the surgical plan to its accurate execution. The manual dexterity, operative versatility, and mature judgement acquired along many years of exclusive dedication to nasal surgery allow for the utmost finesse in assessing the risks and benefits of each individual surgical manoeuver. Hands and mind of the surgeon must be guided by the search for the best possible balance between a series of anatomical changes and significant individual variables (sex, height, age, facial features, and wishes of the patient).

When the structural support of the dorsum or tip is insufficient, the surgeon must be prepared to obtain material from other sites, like ears or ribs. The obvious consequences include increased technical complexity, risk of untoward side effects at the donor sites, and lengthening of the operative procedure. All these critical issues, more than a specialization, require surgical super-specialization.

Rhinoplasty in Milan with Pietro Palma, one of the leading experts in Italy and in the world

Dr. Palma has dedicated the past 25 years of his professional career to rhinoplasty, surpassing the level of a specialist and becoming a super-specialist in plastic and functional nose surgery. This professional evolution required continuing improvement in both surgical education and finessing of the operative skills. Dr. Palma’s focus, research, and developments have enabled him to develop an innovative surgical approach called Hybrid Rhinoplasty™. This exclusive formula sums up a “made to measure” operation based on systematic planning and absolutely patient-specific execution.

Meticulous design, tailor-made surgery, establishment of a relationship based on empathy and trust between surgeon and patient represent the hallmarks of Dr. Palma’s YOUnique Rhinoplasty™, a European registered brand.

The complex challenge posed by rhinoplasty demands a rich repertoire of specific technical skills as well as high-level professional maturity, both before and during the execution of the surgical plan. Dr. Palma’s super specialization enables him to tackle the most complex rhinoplasty revision cases. His considerable accomplishments include more than 200 scientific publications, collaborations with leading academicians and world-renowned rhinoplasty surgeons. Driven by an inexhaustible yearning for innovation and excellence in practice, Dr. Palma pays close attention to quality of care and safety in rhinoplasty/septorhinoplasty. He is considered one of the leading rhinoplasty surgeons on a national and international level.

The rhinoplasty expert is available for exploratory interviews at Clinica del Viso (tel +390263611932 – info@youniquerhinoplasty.com) or Casa di Cura “LA MADONNINA” (tel +390258395555 – cup.cclm@grupposandonato.it), both in Milan and easily accessible from abroad.

Testimonials

  • “From the onset, I knew he was the one. … Prof Palma approached the consultation differently… He came across as being able to combine technical skills, with anatomical expertise and the artistic mastery needed to achieve optimal 3D results.”

    Patient review of realself.com
  • “I found Pietro Palma online and was off to Milano for a consultation a month later.
    He truly is an artist. He had a clear vision of what he would have to do to give me the result I wanted. The operation was extensive. He gave me a radix graft, he deprojected the tip, he took the tip back and made it smaller and narrower, and reduced my nostrils…. I like the fact that I still look like me.”

    Patient review of realself.com
  • “I am super grateful for the wonderful work you and your great team have done for me. You and your team are the ultimate example for me of how a health care team supports and delivers the best possible improvement to a patient’s life!”

    HS, The Netherlands, via email
  • “Dear Prof. Palma, we send our warmest regards to you from Baku! Everybody is happy with S…… nose, especially S……. It is a perfect great job and we are very grateful to you!”

    Family A., Baku, Azerbaijan via email
  • “Being from London, I had the opportunity to consult with several plastic surgeon. When I saw the gallery on his website, each result was fully adjusted to the person’s face and nothing looked unnatural or overdone. … I knew that the only surgeon I could trust was Prof. Palma. The result is so natural, fits my face perfectly and is exactly what I was looking for.

    Patient review of realself.com
  • “I am absolutely delighted with the result of the surgery! I would not have dared to anticipate such a refined and fitting outcome due to the previous surgeries and consequent limitations.
    Italy certainly now has a special place in our hearts for being a positive part of a difficult year by virtue not just of now having a nice nose (!) but the warmth and kindness experienced by myself and my dear mum.”

    JC, UK via email
  • “I found Pietro Palma online and was off to Milano for a consultation a month later. He truly is an artist. He had a clear vision of what he would have to do to give me the result I wanted. The operation was extensive. He gave me a radix graft, he deprojected the tip, he took the tip back and made it smaller and narrower, and reduced my nostrils. I like the fact that I still look like me.”

    Patient review of realself.com
  • “He is warm, honest and professional. …. He only does rhinoplasty, which is a testament to the respect he has for this complex branch of plastic surgery. He calls rhinoplasty the “final destination” of esthetic surgery. Which is pretty cool.”

    Patient review of realself.com
  • “Thank you for everything you’ve done for me! I am really glad that we’ve met, that I made such a long journey from Baku to Milan and met such a great surgeon like you.”

    IJ, Baku, Azerbaijan – via email
  • “I traveled from the UK during mid-2016 for Revision Rhinoplasty with Professor Palma who performed my FOURTH nose surgery. The result? Speechless when I first saw it and still amazed one year later! I’m delighted with the result and it feels entirely natural… I think he is a wonderful, uniquely talented surgeon and feel fortunate to have had a doctor of his standing and expertise take on my case.”

    Patient review of estheticon.com
  • “I have always wanted a rhinoplasty, but never trusted anyone before I have met Prof. Palma. I am from Bulgaria and travelled to Milan. I stayed in Milan for 10 days after the surgery and the Professor made my post op very easy, seeing me 3 times, and when he took the bandage away I was happy with the wonderful work he had done with my nose. I am very proud of knowing such a great surgeon and professional, but also such a nice man. I definitely recommend him to everyone.”

    Patient review of estheticon.com
  • “Prof. Palma, thank you for everything, for breathing, for a beautiful nose, for being such a caring doctor, for such a helpful staff. I am very happy!”

    IT, Vienna – via email

Tutoring

Endonasal Hybrid Rhinoplasty

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My team

Irina Vasilenko

Co-Founder YOUnique Rhinoplasty ™, ENT Specialist & Plastic Surgery

Giovanni Padoan

ENT Specialist, Endoscopic Paranasal Sinuses Surgery

Luciano Palminiello

Anesthesiology and Resuscitation Specialist

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