The Rhinoplasty procedure

Rhinoplasty is a nose-reshaping plastic surgery that can be performed under local anesthesia (you are awake) or under general anesthesia (you are asleep). Cosmetic nose surgery is often performed in a doctor's outpatient surgical suite. Rhinoplasty normally requires two hours or so in surgery, depending on the amount of nose reshaping to be done. Two types of rhinoplasty include "open" versus "closed."

A rhinoplasty is usually an augmentation or a reduction (shortening or lengthening) rhinoplasty. It may also involve deviation of either the cartilaginous or the bony dorsum and usually involves some degree of narrowing and straightening of the nose.

It may also involve straightening of the septum, the central partition separating the 2 nasal passages. For patients suffering concomitant sinusitis, it may also be possible to combine this procedure with endoscopic sinus surgery.

INCISIONS AND RESHAPING: CLOSED vs. OPEN

Open Rhinoplasty. For major nose reshaping , the incisions are not made inside the nose. Instead, a v—shaped incision is made in the vertical strip of skin separating the nostrils. This is called the columellar incision, which is then extended to each side within the nose, and therefore this extension remains invisible. This more complex procedure is referred to as "open" rhinoplasty. This technique allows for more precise re-shaping of the tissues and the scar is almost invisible. This is the more preferred technique in the surgeon's hands as precise symmetry is achieved.

The next step is to re-shape the tip of the nose. This is done by working on the lower lateral cartilages and narrowing them in the region of the dome. This narrows the tip of the nose.

The hump of a prominent nose usually consists of a bony and cartilaginous part. Both are reduced to the required degree. Then the upper part of the nose which is formed by the nasal bones is narrowed by osteotomies, which means precise controlled fracturing of the bones. There are many reasons that the surgeon would want to narrow the nasal bones during a rhinoplasty.  Maybe the bones make the nose appear too wide.  Maybe either bones, or only one bone, have been pushed abnormally wide in a car accident.

After the cartilage and bone have been altered, the nose tissues are redraped over the newly shaped structures and the incisions are closed.

Closed Rhinoplasty. For minor reshaping, many surgeons make incisions within the nose. The skin of the nose is then separated from the bone and cartilage, which forms its supporting framework. Once exposed, bone and cartilage can be augmented, removed, reshaped, or rearranged to achieve the desired new shape. For example, to make the nasal tip narrower, cartilage can be removed from within the nose