How is rhinoplasty accomplished?
Rhinoplasty is accomplished by combining various surgical maneuvers to address common aesthetic concerns such as a hump seen on profile, a bulbous tip, a drooping tip, or asymmetries. Changes are made to the structural framework inside the nose in order to achieve the desired outside appearance. Internal changes can be made to improve breathing problems at the same time.
There are three structural parts to the nose that determine outside shape and influence breathing capability. The upper portion consists of bone, the middle portion cartilage (called upper lateral cartilage), and the tip also cartilage (called alar cartilage) (Figure 1, left). The nasal septum is a cartilage strut that divides the nasal airway into two sides and provides support for the middle and lower thirds of the nose (Figure 1, right).
Bone is removed from the upper third of the nose to remove a hump. Later in the procedure the bones are moved inward to reduce the width and thereby restore a normal cross-sectional configuration to the upper nose (Figure 2). The middle third cartilages are also reduced because they contribute to the lower part of the hump, as does the septum. They are also shortened in order to allow the tip to rise. The lower third cartilages are typically reduced in dimension to make the tip less bulbous and also to allow the tip to rise. The cartilages are also bent inward with stitches to narrow the tip (Figure 3). The lower part of the nasal septum is also shortened to help elevate a drooping tip. These are some of the common surgical maneuvers performed during rhinoplasty. There are many others used to address specific issues.