There are as many problems as there are noses and this makes rhinoplasty one of the most difficult operations in plastic surgery. Solutions are always “custom made” and require a deep understanding and discussion of the following elements:
I will therefore only discuss the problems in a very basic way. Fine-tuning is the domain of the personal face-to-face consultation.
Bridge of the nose: side view
Can be caused e.g. by a crooked septum or a traumatic impact on the lateral bones
Nose with a marked hump
A very frequent problem caused by too much development of the bony and
cartilaginous hump. This is mostly an inherited trait.
Underdevelopment of the nose
Rare in a Caucasian nose, but more common in African and Asian noses. The approach is to augment the bridge with cartilage taken from the septum or the ear.
Flat nasofrontal angle
There is no angle between forehead and root of the nose
A difficult situation to correct as shaving off of the bone needs to be done very precisely. The bone is rather thick, which adds to the difficulty.
Bridge of the nose: frontal view
Bridge too broad
Happens frequently in African and Asian noses. This can be tricky because there are very few options to narrow the nose in these cases. Sometimes these noses lack projection also. An augmentation of certain structures is a possible solution
Bridge too narrow
Can be caused by previous surgery or as a natural feature.Grafting of cartilage -so called spreader grafts - can bring a solution
Asymmetrical structures in frontal view
A trauma, previous operation or asymmetrical development of the nose can be the cause. The septum can be crooked too.
Tip of the nose: side view
To much projection
Happens a lot in Caucasian noses. The alar cartilages may be too long; the septum may be too projecting. Reduction is done by working on the cartilages
Not enough projection
Very rare. Pieces of cartilage can be implanted to support and extend the shortened cartilaginous structures
Shape of the tip
The alar cartilages create an undefined round tip. Very often there is also a thick skin.The alar cartilages need to be modified. Lateral cartilaginous parts need to be taken out, the tip needs a bit more projection with cartilage implants
The tip is square, because of overdevelopment of the lateral part of the alar cartilages. resection of cartilage and grafts will solve the problem in most cases.
Sharp and projecting tip
The “C” shaped alar cartilages are too long and push the nose forward.Resection of the most prominent part of the alar cartilage and suturing of both ends is one solution.
Quite common in African noses.A segment of the nostril can be taken out to reduce the width.
Very rare. Can be caused by previous surgery when too much cartilage has been taken out and the scar tissue made the underlying structure collapseCartilaginous grafts can be inserted
E.The nasolabial angle
Angle too obtuse(norm: 90°-110°)
Because of an overreaction of the septum, the tip tilts upwards.The septum should be corrected with cartilage grafts
Angle too sharp
This could be caused by a large, hanging septum frequently in combination with a hump. Both the hump and the septum should be resected.
A short lip can be the symptom of a large hanging septum, which pulls the lip upwards. The septum can be shortened.If the lip is indeed too short, there are no options to correct this
A long lip can be shortened. This procedure is explained in the chapter about lip surgery