“Queen Elizabeth’s Rhinoplasty”
by
J. G. Ballard
Many views were expressed as to what would be the ideal shape of the Queen’s nose, and how it could best be obtained. Some of her surgeons favored the profilometer (Straith, 1938), by which Her Majesty’s nose would emerge after operation with a standard height, tip angle, and bridge line. Other surgeons modeled the patient, trying out various patterns of the future nose in the attempt to obtain Her Majesty’s approval for a particular one.
The principle here was rather like that of trying out a new hat.
Unfortunately, human tissues are prone to thicken and behave in a way that is unpredictable. It was felt unwise, therefore, to lay too much emphasis with Her Majesty on exact details. Generalities were discussed, such as whether a straight or a hollowed-out bridge line was to be aimed at, whether her nose was to be retrousse or not, and whether the tip was to be narrowed or left alone.
Preoperative preparation. The Queen’s nostril vibrissae were cut short and her nose packed with cocaine and adrenalin as for a submucous resection of the septum. General anesthesia was preferred, the Queen’s trachea being intubated and the pharynx carefully packed off around the tube.
The incisions. Bilateral vestibular incisions were made through
the lining of the lateral wall, placed between the alar cartilage and the lateral cartilage. These incisions were carried forward over the apex of each of Her Majesty’s nostrils and met centrally at another incision made by transfixing the septum just below the lower border of its cartilage.
The skin covering of the Queen’s nose was freed on a deep subcutaneous plane right up to the glabella and well around to the sides. This was done with a pair of small curved scissors with blunt points. Where the saw cuts were to be made along the posterior margins of the Queen’s nose, an elevator was introduced via the small lateral incisions. A pair of straight scissors carried up on either side of the cartilaginous septum now left this structure standing free and allowed the lateral cartilages to fall away on the sidewall of the nose, being carried in a mucosal flap. The septum was then trimmed along its anterior aspect to complete the reduction of the bridge line.
There were two schools of thought regarding the instrument to be used for the bone section. One favored the use of the osteome; the other preferred the saw. Much was made of the dangers of bone dust, and its part in producing thickening after operation. Joseph’s nasal saws angled differently for left and right sides were good saws for the purpose. In the revision of the nose tip after previous unsatisfactory surgical intervention, asymmetrical alar cartilages presented special problems difficult of solution by the usual intranasal techniques. The so-called “Aying-boat approach was employed, as described by Rethi (quoted May 1951).
The radical operation on the Queen’s nose carried with it a tendency to bleed. Hematoma formation would lead to excessive thickening, and possibly even to infection. Iced compresses during the first forty-eight hours diminished the edema that occurred in the Queen’s eyelids and cheeks. Packs were removed after twenty-four hours. Her Majesty’s nose was interfered with as little as possible during the next few days, the air way being cleaned with a pledget of cotton wool. The splint was removed after seven days and the Queen instructed in the digital pressure required to maintain the position of the nasal bones. A brisk reactionary hemorrhage was controlled by packing.
Her Majesty was warned that some bruising (black eyes) was likely up to three weeks after the operation, and that her social activities would have to be curtailed. The Queen was also informed that she should not attempt to blow her nose until the intranasal incisions were soundly healed (two weeks).
During after-care, Her Majesty found it difficult to understand that her nose was swollen, and that such edema would settle down slowly and irregularly. Her Majesty was warned that her nose should not be operated upon for a further time within six months of the previous operation.
Biblioklept 