Rhinoplasty comes in many forms. When people think of nose surgery to improve appearance, most commonly we think about making noses smaller. That is, big dorsal humps being rasped or shaved down, or bulbous or full tips being trimmed and narrowed.
Indeed, subtractive rhinoplasty is generally the most common type of nose surgery performed to improve nasal appearance for primary rhinoplasty (rhinoplasty being done for the first time).
However, when it comes to rhinoplasty revision (also called secondary rhinoplasty), addition, not subtraction, is often the rule. Why is this? Well for one, over aggressive subtractive surgery can lead to deformities, loss of nose support, and poor healing. Overcorrected humps can lead to scooped out appearances. Or, too much removal of lower lateral cartilage (cartilage that forms the side of the tip) can cause pinched tips.
This case demonstrates addition rhinoplasty where the nose is purposefully made larger to improve appearance. This young man had two prior rhinoplasty surgeries over the course of 3 years.
He was unhappy with the flat appearance of his nose. To correct this, cartilage was added to the nose with addition of more support using stitches and cartilage grafting.
Because he had prior surgery for corrective breathing, much of his septal cartilage was already gone. Thus, the cartilage harvested for this procedure came from his ear with a very small, well hidden incision in the crease behind the ear. The harvest of ear cartilage leaves no ear deformity.
All grafting was performed from incisions within the nose. While the nose is now bigger and better, his face is still unbalanced. It could benefit from further addition. Can you guess what addition would improve his profile? Yup, a chin implant.
Chin implants are generally performed through either external incision or intra-oral incisions. I prefer the intra-oral approach with a small incision just outside the gum line, leaving no visible car and precise positioning along the lower mandible or chin.
The last form of addition surgery is fat grafting or injectables. Often, fat injected into the cheeks, cheek bone, or the hollowed out area under the eye balances the face and nose. And, the the nose, lip, and chin can also be harmoniously balanced through augmentation of these regions.
In the end, while the nose is indeed the centerpiece of the face, it is the surrounding structures that can enhance or detract from this focus of attention. Critical diagnosis of the surrounding facial elements are thus paramount when beautifying a nose.
For more on fat grafting click here.
To learn more about rhinoplasty click here.
For more on chin augmentation click here.
Dr. Tim Neavin is a board-certified plastic surgeon located in Beverly Hills, California.