Rhinoplasty techniques | Open rhinoplasty, Closed rhinoplasty, Incisions, Cartilage grafting, & Osteotomies

Naficy Plastic Surgery & Rejuvenation Center

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Rhinoplasty's are complicated

Rhinoplasty are by far one of the most complex and artistic procedures in facial plastic surgery. Dr. Naficy's practice has been 100% devoted to rhinoplasty and facial plastic surgery for the past 15 years. Trust your nose to an expert!


"Patients' Choice Award" by Vitals.com

Dr. Sam Naficy has been awarded the "Patients' Choice Award" by Vitals.com - a website dedicated to rating the quality of physicians across the country. Out of 720,000 physicians, only 5% received this honor.

Rhinoplasty Surgery

Rhinoplasty surgery techniques have evolved a great deal over last 2-3 decades. When rhinoplasty was a young specialty, rhinoplasty techniques were more crude and primarily involved removal of cartilage and bone. This technique of reduction rhinoplasty worked well in some types of noses but had poor outcomes with others. The weakening of the structural support of the nose would often result in collapse or undesired shape or asymmetries, not to mention nasal obstruction.

Gradually there was a shift toward a more conservative removal or excess cartilage and bone coupled by reshaping (as opposed to removal) of the structures that were left behind, thus removing less and preserving more structure.

Advanced rhinoplasty techniques today involve reshaping of the nose while maintaining structural integrity. Rhinoplasty results are more predictable and more natural and there are much less long-term breathing issues than there were 20 years ago.

Incisions: open rhinoplasty vs. closed rhinoplasty

The difference between the incisions in open vs. closed rhinoplasty is quite minimal. Both open rhinoplasty and closed rhinoplasty involve incisions inside the nose. Open rhinoplasty has a small component that crossed between the nostrils.

Closed rhinoplasty incisions (left) compared with Open rhinoplasty incisions (right)

The main advantage of open rhinoplasty is that is allows the surgeon to see the anatomy of the nose very well and to be able to do a more precise job during the rhinoplasty procedure. The vast majority of experienced rhinoplasty surgeons today use the open rhinoplasty approach.

The main advantage of the closed rhinoplasty is that there is less swelling and numbness of the tip after surgery. The closed rhinoplasty technique however is decreasing in popularity since modern rhinoplasty techniques demand a better ability to see the nose than is possible with the closed rhinoplasty technique.

Incisions: when are incisions made on the sides of the nose?

Incisions along the sides of the nostrils are necessary in rhinoplasty when the nostrils are wide and flaring and need to be reduced in size. This technique is called alar base excision and the resulting incision falls in the groove under the nostril.

African American rhinoplasty patient with flaring nostrils before (left) and after open rhinoplasty with alar base excision (right)

how is cartilage removed?

When there is excess cartilage in the nose it can be removed during rhinoplasty using precise instruments. Since cartilage is the main structural framework of the nose, as excess cartilage is removed during rhinoplasty it is necessary to leave behind enough support to avoid problems with nasal obstruction, collapse, or pinching.

How is cartilage RESHAPED?

During rhinoplasty, cartilages of the tip of the nose are reshaped using a variety of suturing techniques. Tip suturing techniques can turn a round, and bulbous tip into a more defined and sculpted tip. It can also help reduce the width of the tip of the nose and can help correct tip asymmetry. Tip suturing also allows correction of a droopy nose or an excessively up-turned nose.

What is cartilage grafting and why is it needed?

Grafting is a term used to describe transfer of cartilage from one place to another place during rhinoplasty. The most common types of grafting material in rhinoplasty include cartilage from the septum, sometimes form the ear, and rarely from the rib. Grafting of some kind is very common during rhinoplasty and most advanced rhinoplasty techniques used today involve grafting of the cartilage removed during rhinoplasty or septoplasty. Some of the more common types of grafts used during rhinoplasty are columellar strut grafts, alar batten grafts, alar strut grafts, spreader grafts, and tip grafts.

How is bone reshaped

During rhinoplasty the nasal bones are reduced using rasps and files. Typically minor changes in the shape and size of the bones can be achieved using rasps and files. More dramatic changes in the shape and width of the nasal bones are achieved by a technique called osteotomies (controlled fracture of the nasal bones). During an osteotomy, multiple small perforations (holes) are made along the desired line of fracture or break and with manual pressure, the nasal bones can be pushed in to effectively narrow the width of the bony portion of the nose.

Is there packing placed inside the nose?

Dr. Naficy does not use packing inside the nose after rhinoplasty. This is very much appreciated by his patients since they can breathe through their nose immediately after surgery and there is considerably less pain when no packing is placed inside the nose.

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Naficy Plastic Surgery & Rejuvenation Center     1110 112th Ave NE Suite 150 Bellevue, WA 98004     (425) 450-0880