Patient Results

Revision rhinoplasty

Revision rhinoplasty
Tip and bridge narrowed using custom grafts. Nostrils refined and made more symmetric.

Natural Rhinoplasty

Natural Rhinoplasty
Large hump reduction with droopy tip elevation. Tip reshaped completely but with natural result.

Ethnic Rhinoplasty

Ethnic Rhinoplasty
Dramatic tip and nasal lengthening and refinement. Diced cartilage fascia graft used to augment bridge. Natural results from major structural changes.

Teenage Rhinoplasty

Teenage Rhinoplasty
Dynamic tip elevation and refinement along with major bridge reduction and de-projection. Nose is now well balanced with face.

Ethnic Rhinoplasty

Ethnic Rhinoplasty
Hanging, bulbous nasal tip, large hump on bridge and long appearing nose. Bridge reduced while refining and balancing the tip shape to match.

Ethnic Rhinoplasty

Ethnic Rhinoplasty
Hooked Hispanic nose with droopy nasal tip and large dorsal hump on bridge corrected and reshaped with natural refinement techniques.

Basic Nasal Anatomy and Aesthetics

  • Primary Rhinoplasty: First (hopefully the last also) rhinoplasty performed
  • Revision or Secondary rhinoplasty: rhinoplasty performed subsequent to or repeated again after a primary rhinoplasty
    • Major, requiring cartilage grafts for collapse or major deformities from original rhinoplasty (often requires sedation or general anesthesia)
    • Minor, needing small amounts of skin, nostril, or cartilage tweaking or fine-tuning (often done with just local anesthesia)
  • Septoplasty: straightening of the septum often done by removing or straightening the most curved portion
  • Turbinoplasty: modification of the turbinates (see below) without removal
  • Turbinectomy: removal of bone and or mucosa of inferior turbinates
  • Ethnic Rhinoplasty: usually refers to rhinoplasty performed on non-Caucasian noses
    • Requires a versatile and full-spectrum skill set in all techniques of rhinoplasty to provide natural results while also creating clear changes
  • Cartilage Graft: a piece of cartilage removed from one location and relocated to another.
    • Grafts are often placed in the bridge to support the bones and help breathing, in the tip to shape the tip, in the alar area to support the nostrils, and/or on top of the bridge to augment the bridge
  • Dorsum: Bridge of the nose
    • Can be “rasped” or shaved down and reduced or augmented with select cartilage grafts (i.e., diced cartilage fascia grafts or straight rib grafts) or silicone implants
  • Radix: Deepest part of nose (at its root, where it meets the forehead)
    • Can be reduced to enhance the eyes more or augmented when too deep
  • Nasal Tip: The bottom of the nose; formed by the tip cartilages
    • Often requires refinement, and its projection can be reduced or increased
    • Also can be elevated or rotated upward and even lengthened in the case of an overly shortened nose
  • Domes: the peak of the tip cartilages
    • Enhanced when tip is refined with suturing techniques and/or grafting
  • Columella: The skin bridge between the nostrils
    • Can be retracted or excessive (hanging columella) requiring modification
  • Alar rims: The skin bridge surrounding the nostrils; the roof of the nostrils
  • Alar base: the base of nostril and can be wide or flared, requiring reduction to narrow the nostrils (alae)
  • Alar sill: the floor of the nostril apertures (holes) or entry into the nostrils
  • Supratip: are just above the tip
    • If full can cause a “pollybeak” tip
    • If too deep can look artificial (excessive supratip break)
  • Dorsal hump: the convexity or bump on the bridge of the nose
    • Requires reduction (“component dorsal reduction”)
  • Droopy tip or plunging tip: an excessively long tip that droops down
    • Can be exaggerated when smiling, causing a hooked appearance
    • Elevation, shortening, and often removal of the depressor muscle corrects this
  • Skin envelope: the skin of the nose
    • Thick skin that is sebaceous (oily) with large pores tends to be less elastic and may not contract to new (smaller) nasal framework after reduction
    • Thin skin envelope: can make underlying nasal changes more visible
  • Septum: cartilage and bony wall that divides the nose into right and left
    • When curved can obstruct the airway and complicate breathing
    • Can also be tilted or have perforations (holes)
  • Turbinates: the structures (3 on each side) that have bone and mucosal lining
    • Responsible for clearing pollution of the nose and humidifying the air in the nose
    • If enlarged (inferior turbinate hypertrophy) can be reduced or excised (partially)
    • Can enlarge during different time periods: moving from hot to cold environments; during menses, with allergic reactions, and with a cold or virus
    • Can be treated with nasal steroid sprays
  • Dynamic tip: nasal tip that moves excessively downward when talking or smiling
    • Can be treated with modification or removal of the muscle attachment (depressor septi nasi muscle)

Hazel E's New Nose after ATV accident
by Dr. Ghavami

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