Nose Reshaping (Rhinoplasty)

Rhinoplasty is a very exacting surgical procedure that requires special training and expertise. With a rhinoplasty procedure, the surgeon can address both cosmetic and functional nasal concerns.

Dr. Muzaffar begins each new rhinoplasty consultation by asking the patient what aspects of the nose he or she would like to have altered or improved. The surgical plan is then customized to achieve the specific goals of each individual patient. A thorough history and physical exam, preoperative photographs, and detailed surgical plan are reviewed with the patient to ensure that Dr. Muzaffar understands the patient's wishes and that the patient has realistic expectations of the surgery.

Rhinoplasty can create changes in the shape and size of the nose, as well as addressing more subtle features, such as the amount of projection of the nose, size of the nostrils, and angulation of the nasal tip. In addition, functional problems (breathing problems related to anatomic abnormalities of the nose) can be addressed in the same operation.

Anatomy and appearance

The appearance and function of the nose are affected by many different factors. The nasal bones, the cartilages of the nose, the nasal septum, and the skin and soft tissues all influence the way the nose looks. In addition, the cartilages and soft tissues of the nostril, the nasal septum, and the nasal turbinates (bony structures inside the nasal passages) influence nasal breathing. All of these anatomic structures can be surgically modified, and an accurate diagnosis is essential in order to determine exactly which components of the nose must be addressed and in what way. In addition, it is important that a full facial analysis be done during the consultation, because the relationship between the nose and the face is critical. In order to achieve excellent outcomes in rhinoplasty, there must ideally be harmony between the face and the nose. For example, the shape and position of the jaws and chin are very important considerations, and in some cases, surgical modification (most commonly of the chin) may be in order.

The procedures

Rhinoplasty can be done using incisions made entirely within the nostrils ("closed" approach) or using a combination of incisions within the nostrils and in the skin between the nostrils ("open" approach). No incisions are made on the more visible parts of the nose.

Depending on the patient's concerns, the surgery may be limited to

  • the tip of the nose,
  • the bridge-- or dorsum--of the nose,
  • the nasal septum, or
  • the other internal structures of the nose, or
  • it may address several or all of these structures in combination, including the nasal bones.

Tip Rhinoplasty

In some cases, only modification of the appearance of the nasal tip and nostrils is necessary or desired. For example, patients commonly may complain that their nasal tip is too bulbous or boxy in appearance, too large, too projecting (sticks out too far), too wide, too narrow, over-rotated (turned up) or under-rotated (plunging nasal tip). In some cases, the muscles of the upper lip can also affect the appearance of the nasal tip with animation (e.g. smiling).

Each of these concerns, and many other types of nasal tip problems, can be addressed by a carefully-designed surgical plan based on an accurate anatomic assessment. Depending on the problem being treated, the procedure may be done using the closed or the open approach. Modification of the nasal tip cartilages is typically required and can be achieved using suture techniques, cartilage grafting, and cartilage resection; sometimes multiple techniques are used in combination to achieve the desired result. The exact method used is determined by a number of factors, such as the condition of the cartilage, the severity of the deformity, the thickness of the skin, and the relationship between the appearance of the nose and the face.

In some patients, the nasal tip plunges or points downward on smiling and animation. This problem is typically caused by a hyperactive muscle in the upper lip that attaches to the nose and pulls the tip down. Correction of this problem can be carried out at the same time as the rhinoplasty procedure through a small incision on the inside of the upper lip.

The Dorsum (i.e. "Nasal Bridge")

The nasal dorsum, or bridge, may have a bump or hump which makes the nose appear too large; it may be sunken or concave; it may be too wide; and/or it may be crooked. These problems can be related to the nasal bones, then nasal septum, or a combination of the two. Again, the procedure is tailored to the problem and the anatomic diagnosis. For example, an isolated dorsal hump can be addressed very well through a closed approach, with modification of both the nasal bones and septum if necessary. In contrast, a complex, crooked nose deformity may require an open approach with extensive modification of the nasal septum and the nasal bones. When the dorsum is deficient, or sunken, cartilage grafting can be used to augment the dorsum to create a stronger nasal bridge.

The Septum

The nasal septum can have a profound influence on both the appearance of the nose as well as the function of the nasal airways. Normally, the septum should be straight and in the midline. However, a "deviated" nasal septum, that protrudes into the nostril or nasal airway can create breathing difficulties. In addition, deviation or curvature in the nasal septum can create the appearance of a crooked nose and also change the appearance of the nasal tip. The septum is also a common source of cartilage used for grafting in rhinoplasty. Surgery on the nasal septum can be done in isolation, through incisions only inside the nose, or in combination with more extensive rhinoplasty procedures, either through a closed or open approach.

The Nasal Bones

The nasal bones form the upper third of the nasal framework and affect the appearance of nasal width, the height and width of the dorsum or bridge, and the straightness of the nose. Often the nasal bones require modification, such as reducing the height of a bony hump, narrowing a wide nasal base, or straightening crooked nasal bones. These procedures are usually done as part of a more comprehensive rhinoplasty.

In many cases, multiple areas of the nose need to be addressed, and a complete septo-rhinoplasty can be performed, with modification of the tip, dorsum, septum, and nasal bones as needed.

After making a careful diagnosis of the anatomic problems that relate to the patient's concerns about their nose, Dr. Muzaffar will design a detailed surgical plan to address each of the elements in question to achieve the desired result.

About Dr. Muzaffar

Dr. Muzaffar has a great deal of specialized training and experience in rhinoplasty surgery. His residency training was done in the Department of Plastic Surgery at the UT Southwestern Medical Center in Dallas, Texas. This Department has for many years been a leader in the clinical and research aspects of rhinoplasty and is internationally recognized for its educational programs related to rhinoplasty. Dr. Muzaffar has authored many peer-reviewed articles and text book chapters on the subject of rhinoplasty, and he considers it one of his favorite surgical procedures.