What are the steps in rhinoplasty?

Rhinoplasty can be performed using a closed approach, in which incisions are hidden inside the nose or an external approach with an incision made across the columella, the narrow strip of tissue between the nostrils. These incisions allow access to the tissues underneath the skin, cartilage and bone, for reshaping, removing and repositioning. The pros and cons of these options are discussed with the patient during the preoperative visit.

The nose is then reshaped by addressing the relevant aspects that need adjustment.

• Bone is shaved to remove a dorsal hump
• Precision nasal bone cuts (osteotomies) are made to narrow a wide nasal bridge
• Cartilage is harvested (from nasal septum or ear cartilage) and added to build up the bridge of the nose
• A strut is added to strengthen or raise the nasal tip
• Cartilage is removed to narrow a bulbous tip
• Cartilage is sewn together to narrow a broad tip
• Cartilage is removed to slim flared nostrils

These techniques can be combined to achieve a more attractive and refined contour and profile.

Once the desired contour is achieved, the skin is re-draped over the re-configured scaffolding. Any incisions, whether internal or external, are then closed using dissolvable sutures. The internal incisions heal without sequelae, and the external incisions, become imperceptible.

A cast is placed over the nose to stabilize bones that have been repositioned. The cast protects the new nasal architecture and is removed after a week.