Rhinoplasty

Nose reshaping surgery (rhinoplasty) adjusts the proportions, angles, and curves of the nose, both within the nose itself and in relation to other parts of the face. A hump on the bridge, nasal width or length, and a drooping tip are among the main reasons for this operation. We can also address deviations of bone and cartilage that make breathing difficult.

You can describe the part of your nose you would like to change in your own words. We develop the surgical plan by listening to your expectations about the hump, tip position, or proportions in relation to your face. Having realistic and healthy expectations is the most important criterion for me.

The structures that form the shape of the nose

A hump on the nasal bridge forms when bone and cartilage project upward. We plan how much of these tissues to reduce according to how prominent the hump is. By shaping the nasal bones, we adjust the width and the transition between the bridge and cheeks.

Cartilage length can contribute to a long nose. When the tip is low or wide, we reshape the tip cartilage. If there is a deviation, we can address structures inside and outside the nose during the same operation.

The nasal framework consists mainly of bone in the upper part and cartilage in the middle and tip. Soft tissue and skin cover this framework. The nasal wings surrounding the nostrils, the nasal base, and the tissue between the nostrils, called the columella, also contribute to the external appearance.

Nasal length and how far the tip extends forward from the face are separate measurements. Forward extension of the tip is called projection, while its upward or downward orientation is called rotation. In a nose that appears long, this distinction can help explain whether the change will address the bridge, tip, or both.

Who may be a candidate?

People who would like a specific change to a nasal hump, width, deviation, or tip shape can be assessed for rhinoplasty. Completion of facial and nasal development, general health, and the relationship between the desired change and existing anatomy inform the suitability decision. A photograph of a nose you like can help explain the change you have in mind. How that appearance translates to your own nose depends on skin thickness, cartilage structure, and facial proportions.

An uncontrolled illness or active infection in the nasal area needs to be addressed before a decision about cosmetic surgery. If there is a breathing concern, the airway inside the nose is also examined. Nasal obstruction in someone who does not want an external change does not, on its own, mean that cosmetic rhinoplasty is needed.

Examination and nasal shape

During the examination, we assess how your nose relates to your forehead, cheeks, and chin. You can share the curve you have in mind for the bridge or the aspect of the tip you would like to change. Describing the contours you want to preserve also helps us understand the shape you have in mind.

Skin thickness and the structure of the underlying cartilage also guide planning. In thick-skinned noses, the cartilage needs to be structurally able to support the overlying skin. Preserving certain connections between the cartilage and skin is also important. We can thin the skin of the nasal tip to the extent its anatomy allows.

We can also use image-editing software during the consultation. These images can help you describe the changes you are considering for the bridge and tip. The edited image is a tool for understanding your expectations and does not promise a surgical result.

In male rhinoplasty, we aim for straight, defined nasal contours with a conservative approach; in women, we aim for soft transitions. In women, tip elevation, bridge curvature, and the transition between the nose and forehead are part of this plan. We also listen to the appearance you would like as we determine which contours to preserve and which to change.

Thin skin can make the underlying bone and cartilage contours clearly visible. Thick skin shows details of the same framework differently. The shape considered for the tip depends on the amount of underlying soft tissue and cartilage support as well as skin thickness.

A front view shows the relationship between the bridge and facial midline and the width of the nasal wings; a side view shows bridge curvature and tip position. A view from below shows nostril shape and columella placement. These views allow width, deviation, and tip position in the same nose to be described separately.

The position of the tip and nasal wings may change when smiling. Facial movements are therefore included in the examination alongside the appearance at rest. If the detail that concerns you is particularly noticeable when you smile, you can show it during the consultation. Appearance in motion helps clarify the relationship between the tip and upper lip.

When assessing deviation, the line from the nasal root to the tip is examined in relation to the midline of the forehead and upper lip. A bridge directed to one side and differently positioned tip cartilages can coexist in the same appearance. The levels of the nasal wing bases and the structure of the right and left sides of the face also affect it. A plan for deviation therefore cannot be developed from a profile photograph alone.

Open and closed techniques

I do not believe there is one good technique for everyone. I assess each patient individually.

In closed rhinoplasty, incisions are made inside the nostrils. In our practice, we use both open and closed techniques, choosing according to your nasal structure and the planned procedures.

In the open technique, an incision through the skin between the nostrils is added to the internal nasal incisions. This allows the skin to be lifted to reach the underlying bone and cartilage. The terms open and closed describe the route used to access these structures.

In the closed approach, bone and cartilage adjustments are carried out through incisions inside the nose. In the open approach, the tip cartilage is exposed for direct viewing. The tissue to be removed from the hump and the intended tip shape are planned separately from the access route. For example, the need for support in the tip cartilage and the width of the bony bridge are surgical decisions involving different parts of the same nose.

Bone, cartilage, and the nasal tip

We generally begin cosmetic nasal surgery with procedures on the hump. We reduce the cartilage and bone in this area as needed. We then shape the nasal bones from the sides and narrow them. In this area, we can use ultrasonic instruments or fine reshaping methods.

Ultrasonic instruments are surgical tools that cut bone using high-frequency vibration. The term ultrasonic rhinoplasty indicates that these tools are used; it does not describe how the tip cartilage will be shaped. Cartilage adjustments are planned separately according to their anatomy.

After adjusting the bridge, we move to the tip cartilage. We shorten long portions, narrow wide areas, and adjust the positions of the cartilages relative to one another. We shape the tip’s relationship with the bridge and its upward orientation according to the preoperative plan.

In tip surgery, sutures can change the shape of the cartilages and their relative positions. When needed, pieces of cartilage called grafts can provide support. Depending on the existing tip structure, options include reducing, repositioning, or supporting the cartilage.

When a procedure for width at the base of the nasal wings is needed, incisions may be planned along the fold where the wing meets the cheek or along the nostril base. Treating the wing base is separate from adjusting the bony width of the bridge. Nostril shape and wing position determine the plan for this area.

The septum, septoplasty, and turbinates

The septum is the wall of bone and cartilage that divides the nasal cavity into right and left sides. A deviation in this wall can narrow the passage of air. Adjusting the deviated parts of the septum is called septoplasty. When included in the same surgical plan as rhinoplasty, it is also called septorhinoplasty.

The turbinates are structures along the side walls of the nasal cavity, covered by an inner lining called mucosa. They help humidify and warm inhaled air. Their size can affect airflow. If a turbinate procedure is being considered, its scope is determined by an internal nasal examination.

Assessment of nasal obstruction considers the septum, turbinates, and narrow airflow regions called nasal valves separately. Septal deviation and turbinate size do not describe the same structure. An internal nasal examination helps determine which areas relate to the breathing concern and whether a functional procedure is needed alongside the cosmetic plan.

During the examination, you can describe which side is difficult to breathe through and when the concern becomes more noticeable. Previous nasal trauma or procedures inside the nose also help clarify the existing structure. A deviation visible from outside and a narrowing of the internal airway may not be in the same area. Appearance goals and breathing concerns are therefore recorded in relation to their respective anatomical structures.

What is revision rhinoplasty?

Revision rhinoplasty involves planning further surgical adjustments to a nose that has already undergone surgery. The term secondary rhinoplasty is also used in this context. The desired change may involve the bridge, tip shape, nostrils, or airflow. Each concern is assessed in relation to the existing tissues to determine the scope of surgery.

The procedures performed on the bone and cartilage during the previous operation, the existing supporting tissue, and the characteristics of the skin covering form the basis of revision planning. Records from the earlier operation, if available, may help clarify this anatomy. Reshaping needs and the need for cartilage support are determined separately.

Profile planning together with the chin

The proportions of the chin, forehead, and cheeks affect how the nose looks within the face. We can plan rhinoplasty together with chin surgery, buccal fat removal (bichectomy), a lip lift, or eyelid surgery.

In profile, a recessed chin can make the forward projection of the nose appear more prominent. Profile planning examines the positions of the nasal root, tip, lips, and chin in the same view. Seeing chin position as well helps clarify which part of the nose is to be changed. If an additional chin procedure is being considered, its scope is determined separately.