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JAMA Patient Page
October 10, 2017

Rhinoplasty

JAMA. 2017;318(14):1406. doi:10.1001/jama.2017.13267

Rhinoplasty, also known as a “nose job,” is a procedure that involves reshaping or resizing of the nose.

There are 2 major categories of rhinoplasty: aesthetic and functional. Aesthetic rhinoplasty involves changing the outward appearance of the nose for cosmetic reasons. The goal of functional rhinoplasty is to improve the nasal airway to decrease obstruction and improve breathing. Rhinoplasty can also entail a combination of aesthetic and functional techniques. Ultimately, functional and aesthetic considerations come into play for all rhinoplasty procedures.

Steps of Rhinoplasty

  • Incision: Two approaches are primarily used for rhinoplasty. The most common is the external or open approach, whereby a small external incision on the columella (the bridge of skin between the nostrils) is made in continuity with incisions on the inside of the nose. The endonasal rhinoplasty technique is done with extensive internal incisions. With either technique, the incisions allow access to the bony-cartilaginous framework of the nose.

  • Correction of nasal obstruction: In functional rhinoplasty, there are 3 primary components of the nose that are evaluated for repair: the nasal septum, the inferior turbinates, and the valves. If there is deviation of the septum (a structure that divides the 2 sides of the nose internally), this is repaired by removing or reshaping the deviated component. The inferior turbinates, when enlarged, can obstruct the airway and thus may require surgical reduction. The nasal valves refer to the narrowest point in the entrance to the nasal cavity and can be augmented in a variety of ways to increase the size of the opening and prevent collapse during inhalation.

  • Nasal reshaping and resizing: A variety of procedures can be performed to obtain desired shape and size of the nose. Some of the most common aesthetic concerns are a dorsal hump, a wide tip, or a crooked nose. Dorsal hump reduction involves removing both bone and cartilage from the roof of the nose to create a more aesthetically pleasing profile. Tip reduction can involve removal of cartilage in the nasal tip and use of sutures to reduce the size of the nasal tip cartilage. Straightening a crooked nose may involve any of a variety of techniques, including osteotomy (breaking the nasal bones) to create more symmetry on frontal view.

  • Closure: Once the surgeon is satisfied with the appearance of the nose, the incisions are closed. Splints are usually placed outside of the nose to maintain stability during the early healing process. In cases of septal surgery, intranasal splints are often used.

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Article Information

Conflict of Interest Disclosures: The authors have completed and submitted the ICMJE Form for Disclosure of Potential Conflicts of Interest and none were reported.

Sources: American Academy of Facial Plastic and Reconstructive Surgery

Topic: Facial Plastic Surgery

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