Rhinoplasty is the surgical reshaping of the external and internal nose for aesthetic improvement, functional restoration of nasal airflow, or both. The nose is composed of upper bony vault, middle cartilaginous vault, and lower cartilaginous tip, each contributing to overall shape and breathing dynamics. Indications include dorsal hump, broad or asymmetric tip, twisted nose, congenital deformities, post-traumatic deviation, cleft-related deformities, and combined functional issues such as internal nasal valve collapse and septal deviation.
Surgical approaches include closed (endonasal) rhinoplasty with all incisions inside the nostrils for limited tip work and dorsal modification, and open (external) rhinoplasty with a small transcolumellar incision providing direct visualization for complex tip work, revision cases, and structural grafting. Modern philosophies emphasize structural preservation and graft-based augmentation over excessive reduction; preservation rhinoplasty techniques aim to maintain dorsal aesthetic lines through subdorsal cartilage release and pushdown/letdown osteotomies. Concomitant septoplasty addresses functional obstruction, and spreader grafts, alar batten grafts, or columellar struts reinforce the nasal valves and tip.
Recovery involves an external splint for 7-10 days, internal silicone splints if septoplasty was performed, periorbital ecchymosis lasting 1-2 weeks, and gradual resolution of swelling over 6-12 months for tip refinement. Patients should avoid contact sports and eyewear pressure for 4-6 weeks. Complications include infection, hematoma, persistent edema, asymmetry, septal perforation, supratip deformity, polly beak, and unmet aesthetic expectations. Revision rates range 5-15%; ethnic, revision, and post-traumatic rhinoplasty are particularly demanding subspecialties requiring extensive experience.