page_title: Rhinoplasty
section_title: Corrections of defect and deformity
hierarchical_section_title: Rhinoplasty / Surgical procedure / Corrections of defect and deformity
caption_attribution_description: English: Rhinoplasty. View of the human skull, showing the bones of the nose that are modified during a rhinoplasty. Those bones are shaded in blue. For orientation, the eye sockets are outlined in red.
context_page_description: Rhinoplasty, commonly known as a nose job, is a plastic surgery procedure for altering and reconstructing the nose. There are two types of plastic surgery used – reconstructive surgery that restores the form and functions of the nose and cosmetic surgery that changes the appearance of the nose. Reconstructive surgery seeks to resolve nasal injuries caused by various traumas including blunt, and penetrating trauma and trauma caused by blast injury. Reconstructive surgery also treats birth defects, breathing problems, and failed primary rhinoplasties. Rhinoplasty may remove a bump, narrow nostril width, change the angle between the nose and the mouth, or address injuries, birth defects, or other problems that affect breathing, such as a deviated nasal septum or a sinus condition.
context_section_description: Cancer – The excision of cancerous nasal skin can cause the loss of skin and internal support cartilage; such resections (surgical removal) usually are via the Mohs’ chemosurgical technique. After removing the cancerous tissues, the reconstructive rhinoplasty will provide skin coverage using either skin grafts or pedicle flaps, (see Nasal Reconstruction, Paramedian Forehead Flap). If the resection of the cancerous skin leads to losing the nose tip, cartilage grafts can be used for support, and to prevent long-term distortion consequent to the force of the contracture of scar tissue.
  Congenital deformity – The correction of vascular malformations and cleft lip and palate abnormalities. In vascular malformations, the progression of the disease distorts the skin and the underlying structure of the nose. Cleft lip and cleft palate defects usually distort the size, position, and orientation of the nasal-tip cartilages. Reconstruction of vascular malformations can involve laser treatment of the skin, and surgical excision of the deformed tissues. When the underlying cartilage support structure is disturbed, cartilage grafts and suturing of the native nasal cartilages can help improve nasal aesthetics by re-orienting the nasal tip cartilages; and cartilage-graft refinements to the nose tip are performed as required.
  Obstructed airways – The restoration of normal breathing by correcting nasal obstruction caused by a cosmetic rhinoplasty wherein nasal cartilages were over-aggressively trimmed, and the nose appears pinched, which compromises nasal potency (airflow), especially when the patient attempts deep inspiration. These grafting techniques restore normal breathing by increasing the size of the nose tip with baton grafts (internal cartilage), and spreader grafts to widen the nasal middle vault. Furthermore, to improve breathing a septoplasty can be performed concurrent to the reconstructive surgery; likewise, if there is turbinate hypertrophy, an inferior turbinectomy can be performed.
  Perforated septum – The reconstruction of a saddle nose caused by a (collapsed) perforated septum, or by autoimmune problems such as granulomatosis with polyangiitis (GPA), sarcoidosis, eosinophilic granulomatosis with polyangiitis (EGPA), relapsing polychondritis, by intranasal drug use, and by excessive nasal aerosol use. The saddle nose deformity resulting from lost dorsum support is reconstructed using autologous bone grafts and rib cartilage grafts.
  Rhinophyma – The correction of late-stage Rosacea, wherein the nasal skin is infected with acne rosacea that reddens, thickens, and enlarges the nose tip; an exemplar case is the American actor W.C. Fields. Although antibiotic acne treatments (e.g. Acutane) can halt the progression of Rosacea, the thickened skin and the fleshy obscuring of the nasal tip can only be corrected with rhinoplasty. Laser excision of abnormally thickened skin is the best rhinoplastic treatment for Rhinophyma; the CO₂ laser and the infrared Erbium: YAG laser are the most effective treatments.
  Wide nose – To narrow a too-wide nose, the plastic surgeon cuts, contours, and rearranges the craniofacial bones to achieve the desired functional and aesthetic outcome of a narrower, straighter nose. To leave no visible, surgical scars upon the new nose, the surgeon effects the osteotome (bone chisel) incisions to the nasal bones beneath the facial skin.
  Illustration 1: The surgeon cuts the excessively wide bones of the upper nasal dorsum (violet) with an osteotome (bone chisel), then detaches, corrects, and relocates them inwards, to a position, between the ocular orbits (red), that narrows the width of the nasal dorsum.
  Illustration 2: The surgeon chisels two cuts (incisions) to the nasal bones, each incision begins at the nasal cavity. The first incision begins at the yellow dot and extends upwards, along the green arrow, until meeting the zig-zag line (red). The second incision begins at the blue dot and extends upwards, along the black arrow, until meeting the zig-zag line (red). Once cut and loosened from the face, the nasa
caption: Illustration 1:
  The nasal bones (violet) of the dorsum identified, for effecting a nose-narrowing rhinoplasty.
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