Rhinoplasty

 

630.<Rhinoplasty>

Rhinoplasty, commonly known as a nose job, is a surgical procedure aimed at enhancing the aesthetic and/or functional aspects of the nose. Typically, it involves augmentation of the nasal dorsum and refinement of the nasal tip.

For tip refinement, both open and closed approaches are available—each with its merits. Open rhinoplasty provides enhanced surgical visibility, while closed techniques offer minimized scarring.

Dorsal augmentation may utilize either alloplastic implants (such as silicone, Gore-Tex, Medpor, or custom 3D-printed forms) or autologous grafts. While alloplastic materials are convenient, they carry a potential risk of foreign body reaction, especially when the immune system is compromised. Therefore, autologous rib cartilage is often preferred for its biocompatibility and volume suitability. To address issues such as warping, rib cartilage can be processed into ultrafine particles, eliminating the drawbacks of both synthetic implants and raw cartilage.

Surgical strategies vary based on anatomical need: dorsal hump reduction for prominent bridges, cephalic trim for elongated tips, derotation wing grafts for short noses, and osteotomies or septoplasty for deviations. In cases of turbinate hypertrophy, submucosal resection may improve airway patency. Tip projection may be enhanced with structural grafting or ultrafine rib cartilage pocket insertion.

Healing of ultrafine cartilage grafts relies on plasma diffusion and typically stabilizes after 3 weeks—requiring careful postoperative care.

Although rhinoplasty can bring the nose closer to one’s desired image, it must be considered that nasal form evolved as an adaptation to ancestral environments. Alterations, if misaligned with climatic function (e.g., cold/dry vs. warm/humid climates), may pose long-term adaptation challenges. Thus, if rhinoplasty is truly desired, the use of autologous materials and minimally invasive techniques is recommended to minimize future complications.

[Rhinoplasty is the art of reshaping the terminal organ of respiration]
– 630mm growing pine tree-
#Rhinoplasty #NasalSurgery #NaturalNose #ClosedRhinoplasty #AutologousCartilage

Depressed Nose Correction

 

629. Depressed Nose Correction

Depressed nose correction is not merely about augmenting a low nasal bridge; it typically involves addressing both the sunken nasal tip and the surrounding bony structures of the nose. In many cases, both the nasal bones and cartilage are weak, and the septum is also commonly compromised. If the depression is due to trauma, the surgery becomes more complex, and when the nose has collapsed due to multiple previous rhinoplasties, reconstructive nasal surgery is often required.

Patients with congenitally depressed noses frequently present with maxillary hypoplasia, which is often associated with a mild form of Binder syndrome. In such mild cases, standard rhinoplasty combined with paranasal augmentation can elevate not only the nasal bridge and tip but also the surrounding midface area. If the nasal tip cartilage is weak, it can be reinforced using costal cartilage, making the tip more structurally sound. For more precise augmentation around the nasal base or correction of the nasolabial angle, particulate costal cartilage grafting can be used to fill the micro-deficiencies in the maxillary bone. Artificial implants, on the other hand, carry a higher risk of infection and often fail to fit snugly against the maxillary bone, leading to potential implant migration or inflammation. Thus, autologous particulate cartilage grafting is preferred.

In trauma-induced nasal depression, the status of the nasal septum must be thoroughly evaluated, and septal reconstruction may be necessary. For non-primary surgeries, it is often better to open the columella to allow direct visualization and control over the septum.

In cases where multiple rhinoplasties have resulted in a severely weakened septum and tip cartilage, making nasal support difficult, a cantilever rhinoplasty is recommended. The term "cantilever" comes from architecture, referring to a structure fixed at one end and free at the other. In rhinoplasty, this concept is applied by inserting a single, long, firm cartilage strut, shaped from costal cartilage, from the nasal bridge to the columella to provide support. A double cantilever graft, using two cartilage struts symmetrically placed on either side of the midline, is used when there is little to no septum left, creating balanced support. In some cases, this method is combined with spreader grafts to widen the nasal bridge, forming a hybrid support system. The L-shaped cantilever graft, a structural cartilage piece shaped like an L, is increasingly used to reconstruct short, collapsed, or severely sunken noses.

Septal reconstruction is generally performed with autologous costal cartilage sliced thinly, mimicking the septum’s natural form. When the septum is entirely absent, structural grafts are arranged in an L-shape to simulate a septal framework, similar to building a steel frame in architecture. This is often done in conjunction with cantilever rhinoplasty.

In summary, depressed nose correction involves rebuilding the framework of the nasal bridge and tip using cartilage grafts, while simultaneously reconstructing the central support with septal grafts to restore the collapsed nasal structure.

[Depressed nose correction is a procedure that reconstructs the sunken parts of the nose by augmenting or rebuilding them with cartilage.]

— 629mm Growing Pine Tree 🌲

Hump Nose Correction: Preserving Structure, Enhancing Beauty

 

628. <Hump Nose Correction: Preserving Structure, Enhancing Beauty>

Hump nose correction (dorsal hump rhinoplasty) refines the nasal profile by addressing an overprojected bony-cartilaginous hump. While traditional structural rhinoplasty involves osteotomy and implant use, it may disrupt the nose’s natural contour and raise risks of infection—especially when synthetic materials are involved.

To reduce such complications, we often prefer autologous tissue like diced costal cartilage to reconstruct and elevate the nasal dorsum safely and naturally. In recent years, preservation rhinoplasty has emerged as an elegant solution. Rather than removing the hump, we reposition the entire nasal bridge using let-down or push-down techniques, preserving the native anatomy and minimizing trauma.

This approach is rooted not only in surgical advancement but also in evolutionary insight—the dorsal hump evolved to condition cold air. Altering it requires thoughtful consideration of both airflow and aesthetics.

Hump nose is often accompanied by other issues like nasal deviation or a droopy tip. A comprehensive facial analysis, including septal deviation, facial asymmetry, and even bite alignment, is essential. In some cases, orthognathic surgery may also play a role.

Cosmetic correction is optional—but when desired, selecting between structural and preservation techniques should be based on anatomy, healing profile, and personal goals.

“Hump nose correction is the restoration of balance—not just the removal of a feature.”
— 628mm Growing Pine tree-

#PreservationRhinoplasty #HumpNoseCorrection #DorsalHump #NaturalNose #FacialBalance #RhinoplastyExpert #ModernRhinoplasty #NoseSurgery #AestheticHarmony #EFILPlasticSurgery

Deviated Nose Correction

 

627. <Deviated Nose Correction>

A deviated nose correction is a type of rhinoplasty that corrects both the external shape and internal structure of a nose that has deviated from the central axis. Both cosmetic and functional corrections are usually performed together.

A deviated nose can result from trauma during childhood that leads to deformation, but it may also occur due to habitual behaviors developed during the growth process. For example, if one consistently sleeps while lying on one side, the nose may be gradually pushed in that direction. Over time, this causes one side of the nose to have a gentle slope and the other side a steep slope.

Similarly, a habitual one-sided smile can cause the nose to deviate. This is because the asymmetric contraction of muscles around the nose can pull the tip of the nasal cartilage to one side, resulting in a crooked nose. The levator labii superioris alaeque nasi muscle originates from the maxilla near the nasal root and inserts into the nasal ala and upper lip, lifting both when contracted. The depressor septi nasi muscle arises near the incisive fossa of the maxilla and inserts into the septal cartilage and tip cartilage, pulling the nasal tip downward during contraction. When one habitually raises the right side of their lip in a crooked smile, the nasal ala is pulled to the right, and the depressor septi nasi on the same side also pulls downward. This creates a C-shaped deviation. If the pull is to the opposite side, an S-shaped deviation can occur. The shape of the deviation depends on how severely the septal cartilage is bent and the asymmetric contraction of the depressor septi nasi muscle on each side.

Additionally, the levator labii superioris muscle pulls the upper lip upward, and during smiling, the area beside the nose is lifted. This interferes with the movement of the nasal ala. The zygomaticus muscles, when overused in a crooked smile, can develop asymmetrically. This causes differences in the flaring of the nostrils, leading to visible asymmetry. Especially when the nasal septum is weak, a long history of crooked smiling makes deviation more likely.

Such a crooked smile often stems from an uncomfortable or distorted emotional state. A twisted mind leads to asymmetrical muscle use in the face, which eventually results in a crooked nose.

So how should a deviated nose be corrected? Since asymmetrical muscle habits can lead to asymmetrical bone structure, re-correction of the nasal bones is necessary. This is done by performing lateral osteotomy on the sides of the nasal bones, and if needed, medial osteotomy may also be added. If there was a previous nasal fracture, osteotomy can follow the old fracture lines.

Correcting only the outer nose while neglecting the inner structure, such as the septum, is insufficient. A simultaneous correction of the nasal septum allows for both functional and cosmetic improvement. Therefore, it is common to perform septoplasty for a deviated septum (see 623mm) in conjunction with the procedure, which often includes trimming the lower portion. It is important to assess not just the external shape but also the airflow through the nostrils before surgery to determine whether nasal obstruction is present on one side.

In cases of asymmetry due to depressor septi nasi or a sharp nasolabial angle, dissection near the anterior nasal spine is performed. Cartilage grafts using diced cartilage can be placed to reduce the influence of the depressor septi nasi, helping to prevent recurrence and drooping of the nasal tip.

Also, with prolonged one-sided crooked smiling, the area around the nose tends to become sunken on the active side. This occurs because muscles like the levator labii superioris alaeque nasi contract to lift the nasal ala and upper lip inward, while the zygomaticus pulls the corner of the mouth outward and upward. This muscle hypertrophy compresses the surrounding bone and drains subcutaneous fat energy from the area, resulting in volume loss and hollowing.

This imbalance causes the nasal tip to shift toward the dominant side of the smile. In such cases, a structural augmentation around the nose is required. Using diced costal cartilage grafts, the sunken area on the smiling side should be more heavily grafted, while the opposite side receives less grafting. This rebalances the nasal tip and recenters both the nasal bridge and tip.

In this way, diced costal cartilage can be inserted over the deviated nasal bridge following lateral osteotomy, effectively masking the crooked contour. Simultaneous grafting around the nose provides a more fundamental correction of the deviated nose.

[Deviated nose correction is a procedure to straighten a nose distorted by a distorted mind.]

– 627mm Growing Pine Tree –

Arrow Nose Correction

 626. <Arrow Nose Correction>

An arrow nose, where the tip droops and nostrils are hidden, creates the impression of a long, downward-pointing nose. Genetically, this shape evolved in colder climates—where longer nasal passages helped warm and humidify air before it reached the lungs. Over time, this led to more developed nasal bones and cartilage, forming a prominent, arrow-like silhouette.

Functionally, overuse of the depressor septi nasi muscle—especially during smiling or lip-puckering—can further accentuate the droop, making the tip fall over time.

Surgical correction focuses on refining and lifting. Instead of altering the nasal bone, we perform a cephalic trim—removing a portion of the upper alar cartilage to shorten the tip. The medial and lateral crura are sutured to enhance tip support, and if needed, autologous cartilage grafts (from the ear or rib) are used to project and rotate the tip.

Using a closed-open hybrid approach, we avoid external scarring and preserve tip circulation. A 1.5cm chest incision allows safe rib cartilage harvesting, which we sculpt into tip grafts and fine particles for dorsal refinement.

To prevent recurrence, we may dissect the depressor septi nasi origin and reinforce the nasolabial angle using rib cartilage micrografts, restoring facial harmony and expression.

This is not just aesthetic—it’s anatomical elegance. Done correctly, arrow nose correction restores balance while preserving the nose’s natural beauty and function.

“Arrow nose surgery is the art of lightening the heaviness of evolution—gracefully.”
—626mm growing pine tree-
#ArrowNose #CephalicTrim #ClosedRhinoplasty #AutologousGraft #EFILClinic #StructuralRhinoplasty

Rhinoplasty for the Upturned Nose

 

625. <Rhinoplasty for the Upturned Nose*

An upturned nose—short, with excessive nostril show—is more than a cosmetic concern; it reflects an underdevelopment of the nasal bones and cartilaginous structures. Genetically, it’s often seen in those with ancestry from warmer climates, where a shorter nasal passage was advantageous for rapid airflow and less need to humidify or warm the air. Evolution shaped the form. But in today’s world, harmony in facial proportions often calls for correction.

True upturned nose correction is not a simple lift or implant. It’s a thoughtful reconstruction. Because the nasal bones are difficult to lengthen, we instead focus on the scroll area between the upper and lower lateral cartilages. This area is carefully released, and autologous cartilage—often harvested delicately from the rib through a 1.5cm incision—is inserted to elongate the nasal structure with lasting stability.

To preserve function and minimize visible scarring, we use a closed-open hybrid technique, avoiding full columellar incisions. This approach maintains blood supply to the tip, reduces downtime, and enhances aesthetic finesse.
When asymmetry exists between the nostrils, we employ derotation wing grafts—a precise method of adjusting each side independently to restore balance while correcting the upturned shape.

If alar flaring accompanies the upturned nose, we discreetly perform alar base reduction, placing stair-step incisions just above the alar crease to naturally conceal scars and prevent unnatural tightness or "droplet" shapes.

Above all, surgical correction should never compromise function. Autologous tissue ensures the nose remains soft, natural, and integrated with the body. Unlike artificial implants, it reduces the risk of capsular contracture or further retraction. Done thoughtfully, this surgery is not just cosmetic—it restores balance, breath, and confidence.

Accepting one’s natural shape is always beautiful. But when change is desired, we believe in safe, anatomical, and elegant solutions tailored to each unique face.

[Upturned nose correction is a graceful elongation of nose by putting interpositonal graft]

— 625mm growing pine tree-

Rhinoplasty for Chronic Rhinitis: A Surgical Perspective

 

624. <Rhinoplasty for Chronic Rhinitis: A Surgical Perspective>

Rhinitis surgery addresses nasal congestion caused by chronic inflammation of the nasal mucosa, leading to symptoms such as sneezing, excessive mucus, and itching. The inferior turbinate plays a crucial role in filtering and humidifying the air before it reaches the lungs. However, prolonged exposure to environmental pollutants and allergens can lead to excessive mucosal swelling, disrupting normal airflow.

Modern surgical techniques aim to alleviate these symptoms. Radiofrequency ablation and HIFU reduce hypertrophic tissue, while turbinate reduction preserves mucosal function. However, radical procedures like turbinectomy may lead to long-term dryness and compromised airway filtration.

Ultimately, surgery does not cure rhinitis but manages symptoms. True healing begins with clean air, a pure diet, deep sleep, and regular movement—nurturing nasal health from within.

[Rhinitis surgery alters nasal anatomy but does not restore natural mucosal balance.]

-624mm Growing Pine tree-

#RhinitisSurgery #BreatheBetter #NasalHealth #TurbinateReduction #SinusRelief #AllergyCare #ENTsurgery #FunctionalRhinoplasty #HealthyBreathing #EFILPlasticSurgery