Augmentation (“Addition”) Rhinoplasty: When Adding Structure Looks More Natural

When “bigger” looks more natural

• Low bridge / flat radix: Adding subtle dorsal height can bring the eyes and midface into harmony.
• Weak or droopy tip: Projection/rotation often improve more with support than with aggressive reduction.
• Collapsed middle vault / valve narrowing: Post-reduction pinching benefits from spreader grafts that widen the internal valve and smooth the dorsum.
• Saddle nose / trauma / prior surgery: Volume and framework must be rebuilt before finesse shaping.
• Context of the face: With microgenia (small chin) or flat midface, modest nasal augmentation can look far more natural than further nose reduction.
  See how balance works in rhinoplasty with facial reshaping.

What we add (and why)

• Radix/dorsal onlay: Raises a low root/bridge for cleaner dorsal lines.
• Spreader grafts: Rebuild middle vault, straighten internal lines, improve airflow.
• Septal extension / columellar strut: Gives the tip a stable “post” for precise projection and rotation.
• Alar batten support: Prevents sidewall collapse on inspiration.
• Tip refinement grafts: Shields and small onlays for definition without thinning cartilage.

Graft materials: septum, ear, rib & alternatives

Autologous cartilage (your own) is my default. It integrates, resists infection, and ages predictably.

• Septal cartilage: First choice for many cases; straight, reliable, limited volume.
• Ear (conchal): Curved; useful for tip/alar support and small onlays.
• Rib (costal): Best for major dorsal buildup, trauma, or revision. Addresses volume needs. Techniques like diced cartilage in fascia (DCF) help reduce warping and soften edges.

Alloplastic implants (e.g., ePTFE, porous polyethylene) can provide volume but carry higher risks of infection and extrusion; I reserve them for select situations when autologous options are limited.

Form and function: breathing matters

Augmentation often improves airflow: spreader grafts widen the internal valve; batten grafts stabilize soft lateral walls; straightening the septum opens the central airway. A beautiful nose that struggles to breathe isn’t a win—we plan for both.

Planning & sequencing

• Three-view analysis: Front (dorsal lines), oblique (light transitions), profile (radix, dorsum, tip vs chin).
• Build before you polish: We restore structure first, then refine contours; doing this backward leads to instability.
• Face context: Small chin or flat midface? We may discuss conservative chin support or midface volume so we avoid overbuilding the nose. For long-term perspective, see 10 years after rhinoplasty.

Recovery & expectations

• Timeline: Splint ~1 week; social swelling 2–4 weeks; definition refines over months. Augmentation swelling can linger slightly longer in the radix/tip.
• Donor sites: Ear = minimal; septum = internal; rib = small chest incision with typical activity limits while healing.
• Activity: Walk early; avoid nose impact; graded return to exercise as cleared.

Risks & how we reduce them

• Asymmetry/irregularities: Managed with precise carving, DCF where appropriate, and careful soft-tissue handling.
• Warping/resorption (cartilage): Minimized with balanced carving, spreader placement, and diced techniques for onlays.
• Infection/extrusion (implants): Reduced by favoring autologous tissue and meticulous aseptic technique.
• Donor site issues: Low with careful harvest and scar care; we review your specific plan and recovery steps.

FAQ

Will a higher bridge look fake?

Not when height matches your facial proportions and soft-tissue thickness. Overbuilding is avoided; subtlety reads the most natural.

Do you use silicone implants?

I strongly prefer your own cartilage. In select scenarios, alloplasts can be considered, but they carry higher complication risks.

Can augmentation improve breathing?

Yes—spreader and batten grafts can stabilize and widen narrowed areas. Functional and aesthetic goals are planned together.