Rhino-Facial Plastic Surgery

 

697. Rhino-Facial Plastic Surgery

Rhino-facial plastic surgery is not just simple nose surgery. It is a comprehensive facial surgery that considers the harmony of the midface structure and overall facial proportions. While rhinoplasty focuses on improving the nose—raising a low bridge, lowering a high one, or straightening a crooked nose—rhino-facial surgery also examines surrounding features. Is the nose sunken? Are the areas around it flat? Is the midface lacking projection, making the face appear long or flat depending on the nose height?

Orthognathic (jaw) surgery often causes nostrils to widen. Also, in cases of dorsal humps, jaw surgery alone sometimes corrects them. Therefore, patients considering jaw surgery should always think about rhinoplasty, either simultaneously or afterward.
For drooping noses (so-called “arrow noses”), maxillary advancement during jaw surgery naturally rotates the tip upward. At the same time, rib cartilage can be grafted to refine the tip and bridge.

When the midface is sunken, rotational jaw surgery can make it fuller. Using submental intubation helps avoid nasal widening and enables simultaneous rhinoplasty. Maxillary advancement ultimately creates a more convex, balanced profile.

In patients without occlusal issues but with a sunken midface, micro-rib cartilage grafts around the nose (nasal base augmentation) and rhinoplasty can be done together to transform a hollow appearance into a more projected one.

Smiling habitually on one side can deepen nasolabial folds and hollow the nasal base on that side. Over time, this causes the nasal tip to collapse asymmetrically, leading to a deviated nose. Continuous unilateral muscle use (levator muscles, zygomatic muscles) gradually bends the nose—twisted expressions creating a twisted nose. Rhinoplasty in such cases is often motivated by a desire to correct not just appearance, but the emotional distortion reflected in it. However, unless the smiling habit is also corrected, recurrence is possible.

If the brow bone is overly prominent, the nasal root may appear too low. One might wish to match the nose to the high brow bone, but this can result in an avatar-like, oversized nose. Rather than augmenting the nose to cover the issue, it’s better to surgically reduce the brow bone directly.

Rhino-facial plastic surgery, therefore, spans from the brow bone to the upper teeth. It involves not only rhinoplasty, but also brow bone surgery, cheek lifting, perinasal augmentation, and jaw surgery—all of which influence the nose and midface. It is crucial to analyze the whole face to determine what underlying issues are causing nasal problems, and to correct them first or simultaneously to prevent recurrence.

[Rhino-facial surgery is about correcting the facial causes behind nasal problems.]
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