There are many different techniques that may be used during rhinoplasty to achieve the patient’s aesthetic and functional goals. All rhinoplasties are performed using either a closed or open technique. With closed rhinoplasty, all incisions are placed on the inside of the nose. With open rhinoplasty, an additional small incision is made on the underside of the nose on the column of skin separating the nostrils, or the columella. While closed rhinoplasty results in no visible scarring, open rhinoplasty affords a better view of and access to the inside of the nose which can be particularly beneficial for complicated cases, revision procedures, ethnic rhinoplasty, and when working on the nasal tip.
Removing a Hump
Removing or reducing a hump on the nose can be achieved with a variety of techniques. The nasal hump is comprised of both cartilage and bone. In some cases, particularly when only the bone is involved, the bony hump may be filed down using a surgical file or rasp. Some surgeons may use a powered rasp. In other cases, reducing or removing the nasal hump may require the use of an osteotome or bone knife to cut or break the nasal bones. Oteotomies can also be performed to correct an overly wide nose or a twisted nose.
Refining the Nasal Tip
There are many techniques which may be used to address the nasal tip. Cephalic resection is a rhinoplasty technique designed to refine and narrow the nasal tip by removing a portion of the cartilage in the tip and it is especially beneficial when addressing a bulbous tip. Alar base resection is a technique which is often performed to narrow a nose that is too wide at the bottom and this can help to create a smaller, narrower nasal appearance. For this technique, portions of the nostril at the base of the nose are removed. Suture techniques involve the careful placement of sutures to redirect cartilage or lift the nasal tip. This technique allows the surgeon to reshape the nose without removing or adding tissue and is particularly beneficial when refining a bulbous tip or elevating a droopy tip.
A variety of grafts may be used during rhinoplasty. Spreader grafts are comprised of rectangular strips of cartilage and these may be used when widening the middle third of the nose or to provide additional support to this area. Tips grafts can be helpful when refining the tip, altering the projection of the nose, lengthening the nose and when performing revision rhinoplasty. Tip grafts are commonly made of the patient’s own cartilage which can be taken from the nasal septum, ear or rib. Plumping grafts comprised of the patient’s cartilage are beneficial when correcting the nasolabial angle, particularly in the aging nose. A strut is a rectangular piece of cartilage which may be used to provide additional support or strength to the nasal tip and sometimes to achieve some amount of tip elevation. Struts may also be used to create a rounder appearance to the nasal tip.