Rhinoplasty Techniques

Rhinoplasty surgery is all about helping a patient achieve a more aesthetically shaped nose or to help him or her experience physical relief from discomfort. Either way, there are many reasons people seek rhinoplasty specialists. In addition, there are many methods and techniques surgeons use to help patients: improve features, build a better profile, remove deformities, straighten and shape the nose, re-build the nasal structure after injury, and to alleviate pain and problematic breathing due to structural issues and illness.

Of course, every nose is different, and every patient's personal vision of the ideal nose is different. A number of rhinoplasty techniques can reshape and correct the nose. This page offers an overview of rhinoplasty techniques, which will prepare you for a consultation with a plastic surgeon, who will discuss which techniques are best for your case in more detail.

As mentioned, the most common rhinoplasty techniques are "open" and "closed" procedures, but there are other variables to consider.

Basic Open & Closed Procedure:

The rhinoplasty surgeon will decide whether to use the open or closed procedure, depending on your individual situation. The difference is where the incision is placed.

Closed Rhinoplasty Technique

In a closed rhinoplasty, all incisions are hidden inside the nostrils, which makes it the most popular option. Although this surgery does not offer as much freedom to the surgeon as an open rhinoplasty, it offers a number of possibilities. The surgeon is able to remove or implant cartilage and bone to reduce or increase the size of the nose. The closed rhinoplasty procedure is elected in cases where the nose is smaller and where there is less of a bridge and a smaller tip at the end of the nose.

Closed rhinoplasty has a number of advantages. It requires less surgical dissection than open rhinoplasty, which reduces the likelihood of surgery-related complications or infections. Closed rhinoplasty poses less risk of reducing the support of the nasal tip. Postoperative swelling and edema are also reduced, and the patient can more quickly recover.

Closed rhinoplasty has fewer risks and complications, especially in elderly patients. Because the surgery doesn't take as long as an open rhinoplasty, the patient doesn't stay anesthetized as long.

Some surgeons cite decreased visibility as a disadvantage of the close procedure. Because the work is done inside the nose, the surgeon's field of view is smaller.

Open Rhinoplasty Technique

The open rhinoplasty technique is a procedure that uses internal and external incisions. Larger noses with longer a longer bridge or more bulbous tip may require the open technique. With the open method, the surgeon cuts the columella, which is the tissue that separates the nostrils. By making this additional incision, the surgeon is able to peel back the skin of the nose and entirely expose the inside structure. Surgeons use this technique because it is easier to see how the nose will become. Patients who have a secondary rhinoplasty are more likely to have the open technique.

While this presents a risk of external scarring, it offers the most unobstructed access to the interior of the nose, which can sometimes translate to a more successful surgery. Because of the increased freedom, an open rhinoplasty can sometimes provide improvements in appearance in ways that a closed rhinoplasty cannot.

While some patients worry about the potential for external scarring, the scar is not always very visible. If the surgery is performed correctly, the scar frequently ends up being rather small and hard to see. Not many people go around staring at the underside of other people's noses!

Proponents of the open rhinoplasty technique point out that the extra cut should not significantly affect recovery, given that the nasal skin heals much faster than the bone and cartilage.

Differences Between Open and Closed Rhinoplasty Techniques

Both open and closed rhinoplasties have situations in which they work very well.

Typically, closed rhinoplasty works better when a patient is looking for only minor changes. If a patient has an overall excellent shape, and has one or two features that he or she would like fixed (such as a very small hump), then closed technique could be a very good option.

A closed rhinoplasty cannot typically be used to address noses that are too long or crooked. This surgery does not significantly alter the shape of the tip of the nose. So, if a patient's nose has a drooping, over-wide, asymmetrical or otherwise unusual tip, a better option might be open rhinoplasty.

Patients who have previously undergone nasal surgery will likely require the open rhinoplasty technique.

Important Rhinoplasty Technique Information

Whether performed with the open or closed rhinoplasty technique, rhinoplasty will cause a certain amount of bruising and swelling.

This is the true with all forms of rhinoplasty. Any surgical alteration of the body will cause some amount of trauma, and this frequently means that there will be bruising and swelling. After your rhinoplasty, you might see swelling of the nose, bruising around the nose and eyes, and some peeling skin around the nose. All of these symptoms are normal and temporary, and they will pass with time.

New Rhinoplasty Techniques

In recent years, a number of techniques have surfaced that alter the appearance of the nose. These rhinoplasty techniques typically are aimed at helping one specific area of the nose, and they include rasping, spreader grafts, cephalic resection, sutures, struts, tip grafts, base resection, plumping grafts and osteotomy.

Rasping is used to smooth and reduce the size of a bony hump on the nose. This is typically done either with a surgical file or with a powered rasp. A powered rasp allows for a greater amount of precision. This technique can cause less swelling and bruising than other methods of hump reduction.

Spreader grafts are rectangular strips of cartilage that are placed between the septum and the upper lateral cartilages. This can help patients who have short nasal bones and long upper lateral cartilage. It can help patients who have especially narrow, wide or extremely long noses.

Cephalic resection is a rhinoplasty technique in which a portion of the cartilage of the tip of the nose is removed. This can narrow and refine the nasal tip. It can be helpful in patients who have an especially bulbous nasal tip.

Sutures can prove helpful in shaping the nose because they allow for the shape of the nose to be changed without the removal or insertion of tissue. By suturing the cartilaginous tissue of the nose, a surgeon can lift and improve droopy noses and nasal tips.

Struts are rectangular pieces of cartilage that a surgeon will place between the cartilages of the tip of the nose. This can add additional strength and support to the nasal tip, and it can help the nasal tip to appear rounder.

Tip grafts are comprised of a patient's own cartilage, usually taken from another part of the nose, and turned into a graft that can refine the nasal tip, change the projection of the nose or lengthen it.

Base resection is a rhinoplasty technique that can narrow a nose that is too wide at the base. In this technique, a portion of the nostril is removed at the base of the nose. This, in turn, helps the nose to appear smaller and narrower.

Plumping grafts are bits of cartilage that are placed underneath the skin at the junction of the nose and upper lip. This can correct an overly sharp angle at the base of the nose and give the person a more youthful appearance.

Osteotomy derives from two words, "osteo", meaning bone, and "otomy", meaning division or surgical incision. An osteotomy involves cutting or "breaking" the nasal bones. This is sometimes necessary to narrow an overly wide nose or to correct a nose that has a significant twist.

Over the years, surgeons have devised a number of rhinoplasty techniques that make this less traumatic than it otherwise could be.

Primary Rhinoplasty

The term primary rhinoplasty refers to the first time the procedure is performed on a person.

It can be performed for aesthetic, functional or reconstructive reasons, or for a mix of all three.During this surgery, a surgeon will restore skin coverage of the nose, create or recreate normal nasal contours, and/or correct and increase nasal airflow.

Secondary Rhinoplasty

The majority of people who undergo nose reconstructive surgery need only primary rhinoplasty.

However, a minority of rhinoplasty patients (5% to 20%) are unsatisfied with their results. In this case, a secondary rhinoplasty (also referred to as a revision rhinoplasty) may be attempted. A secondary rhinoplasty is any nose operation that is performed to correct, revise or improve upon the results of a primary rhinoplasty.

In general, patients cite two main reasons for dissatisfaction with their primary rhinoplasty. The first is cosmetic: A patient might simply be unhappy with the results. This could come through mistakes made by the surgeon or through a lack of communication between the surgeon and the patient.

The second reason is functional. Just as some patients turn to nasal surgery to correct breathing problems, some patients turn to secondary rhinoplasty for the same reason. Sometimes an initial surgery that is meant to correct breathing problems might not be successful. In some cases, a secondary rhinoplasty can rectify these problems.

Secondary rhinoplasty surgeries are typically more complicated than primary ones. Because of this, secondary rhinoplasty is typically performed using the open technique, which makes the nose more clearly visible and accessible to the surgeon, which allows him or her to more easily see and correct nasal deformities.

Speak With Your Rhinoplasty Surgeon

Your nose is unique, and its features will determine which rhinoplasty technique would work best. Other factors that will influence the technique are your own goals and your surgeon's preferred method. Questions of a rhinoplasty surgeon's skill and competency are as important as which technique is used.

To find out more about which rhinoplasty techniques could work best for you, schedule a consultation with a rhinoplasty surgeon. After examining your face and speaking with you about your goals and medical history, he or she will give you detailed information that matches your circumstances. He or she should be able to tell you the best rhinoplasty technique for you, what results you can expect, how much the surgery is likely to cost, how long your recovery will take, and much, much more.

Use our rhinoplasty surgeon directory to find a rhinoplasty surgeon near you!