Rhinoplasty types and techniques

Nose surgery, as a vast and complicated specialty, requires the use of various rhinoplasty types and techniques in order to achieve the best aesthetic and functional results. However, it is important to note that every person has unique nasal structures, which means that a one-size-fits-all approach may not be efficient in meeting the aesthetic goal of different people.

Some people might require a narrowing procedure, while others need to make the nasal frame bigger. Surgeons may need to remove or add parts to the nose, or provide additional support with grafts, to achieve the desired result. The surgical approach for functional rhinoplasty differs from cosmetic nose surgery and sometimes a combination of both is necessary to achieve the best outcome.

Through this article, we will talk about rhinoplasty types. You can find more detailed information on each type of rhinoplasty in its respective part.

What are the different types of rhinoplasty procedures?

There are several types of rhinoplasty procedures, each tailored to address specific issues with the nose. Let us go through all these different kinds of rhinoplasty and their specific characteristics to see how they bring out the desired functional and aesthetic result.

Different types of rhinoplasty are:

• Open and closed rhinoplasty
• Nonsurgical rhinoplasty
• Revision rhinoplasty
• Piezo rhinoplasty
• Ethnic rhinoplasty 
• Functional rhinoplasty
• Septorhinoplasty

Before getting into details, we need to distinguish the difference between rhinoplasty types and rhinoplasty approaches. This will help have a better understanding of the whole rhinoplasty process. 

Also, these can be both female or male rhinoplasty surgeries.

Surgical approaches

To begin with, both open and closed rhinoplasty are commonly referred to as rhinoplasty approaches. All rhinoplasty types are performed via the two surgical approaches, open or closed. Rhinoplasty approaches are the initial steps for every nose surgery. Through these approaches, the surgeon gains access to the internal nasal structures and can carry on the surgical procedure (1).

Open rhinoplasty

In the open rhinoplasty approach, the surgeon makes a small incision on the skin of the lower part of the nose called the columella. The columella is located between the nostrils. After the incision, the surgeon lifts the skin and the underlying soft tissue to access internal nasal structures. 

This approach provides better accessibility and visibility into the nasal cavity. Yet this approach may increase the chance of scarring. 

Closed rhinoplasty

The other surgical approach for rhinoplasty is the closed rhinoplasty approach. In this approach, the incisions are made inside the nostrils. No external cut on the skin is done in this approach. There is no chance of external scarring in the closed rhinoplasty approach. However, the accessibility is limited. 

Depending on the patient’s requirements, nasal structure, and less importantly surgeon’s preference they can go with either the open approach rhinoplasty or the closed approach rhinoplasty.

Now that we know the importance of rhinoplasty approaches, let us explain different rhinoplasty types.

Operation Types

The way the surgeon performs the operation is a defining factor in the type of rhinoplasty. For instance, improving the aesthetic aspects of the nose requires a different method than improving its function. The way the surgeon operates a primary nose surgery is not the same as when they want to correct deformities from previous surgery. Additionally, patients from different continents with varying nose shapes cannot undergo the same type of operation and expect identical results. 

For all the reasons mentioned, we need a wide variety of operation types to achieve the best surgical outcome for each patient individually. The types of operation help create a customized nose form for every patient according to their specific desires and needs.

With that in mind, let’s dive into the details!

Traditional rhinoplasty

When rhinoplasty was first introduced, there was only one way to operate the nose, and it remained that way for many decades. That’s why we refer to it as traditional rhinoplasty. It was a one-type-for-all operation that would give the exact outcome for all patients, regardless of their differences. Nowadays, we have specific types of nose surgery for every purpose and tailor the nose for each patient separately. Surgeons carry out the procedure specifically considering all the differences and requirements.

Functional rhinoplasty

In addition to cosmetic aspects, functional types of rhinoplasty procedures are there to help patients with their health issues and nose functions. Functional rhinoplasty treats breathing problems and associated issues such as nasal obstruction. Functional rhinoplasty improves people’s quality of life.

Reconstructive rhinoplasty is a form of functional rhinoplasty that works on restoring the normal function of the nose after trauma, injury, or cancer. The nose surgeon reconstructs the nasal structures using different techniques and maneuvers. Most of the time, at the same time the surgeon also contributes to the appearance of the nose to boost the person’s self-esteem as well as their life quality.

Ethnic rhinoplasty

People of different ethnicities have unique and distinctive facial features. Ethnic rhinoplasty is the art of nose surgery for people of different regional and racial backgrounds. According to different ethnic populations around the world, there are several types of ethnic rhinoplasty. The main focus of ethnic rhinoplasty is to improve the nose shape while preserving the racial identity of each population. The several ethnic types of rhinoplasty surgery are:

• Middle Eastern rhinoplasty
• Asian rhinoplasty
• African American rhinoplasty
• Hispanic rhinoplasty

An expert surgeon who is specialized in this challenging type of rhinoplasty enhances the natural beauty of their patients from each ethnicity.

Septorhinoplasty

Among different types of rhinoplasty procedures, septorhinoplasty is where cosmetic surgery meets functional nose job. During septorhinoplasty, the surgeon corrects the nasal septum’s problems such as a deviated septum and subsequent breathing difficulties. Another part of septorhinoplasty is reshaping the nose for a better appearance. This is a life-changing surgery as the patient will benefit from both aesthetic and functional results.

Revision rhinoplasty

Sometimes the patients are not satisfied with the result of the nose surgery they had. It can be because either the surgery failed to address the issues they had, or caused some deformities and complications. The practice of rhinoplasty to correct these deformities or functional issues is revision rhinoplasty. It is understandable why people also refer to this type of rhinoplasty surgery as secondary rhinoplasty.

It is important to decide to have this type of rhinoplasty surgery with an experienced surgeon. The surgeon should be able to use different rhinoplasty techniques to achieve the best aesthetic result while restoring the normal function of the nose. Based on the structural deformities, the nose surgeon chooses the right surgical approach for rhinoplasty. This nose remodeling surgery can improve the patient’s quality of life and confidence.

Nonsurgical rhinoplasty

As you can guess from its name, this nose-reshaping procedure is not done by surgery. The results of this non-invasive type are temporary. They don’t provide permanent changes on the nose and should be repeated if the person wants the same long-term results.

The surgeons use several materials for a nonsurgical nose job. Based on the material they use, nonsurgical rhinoplasty has 3 subtypes:

1. Liquid rhinoplasty: It works by injecting a dermal filler, such as Hyaluronic acid, into specific areas of the nose to address various aesthetic issues. This liquid rhinoplasty surgery is commonly used to even out minor imperfections, address slight asymmetry, fix deformities resulting from previous nose surgery, or fill concave portions of the nose.
2. Botox rhinoplasty: This procedure can improve the appearance of the nose by addressing minor imperfections, lifting the tip of the nose, filling in holes or concave portions of the nose, fixing deformities resulting from previous nose surgeries, and creating nasal symmetry.
3. Thread lift rhinoplasty: It is a non-surgical procedure, particularly in East Asian countries, that can enhance the appearance of the nose by increasing collagen formation, enhancing the dorsum of the nose, and correcting asymmetry by improving the position of the cartilage.

The outcome for each method is unique. The doctor chooses the best option according to what the patient requires. The table below shows different methods of non-surgical rhinoplasty.

Nonsurgical types	Distinctive feature	Lasting time
Liquid rhinoplasty	An injection under the skin. The most common dermal filler is Hyaluronic acid (2).	Last 6- 12 months. Repeating the injection is needed for long-term results
Botox rhinoplasty	A neurotoxin is injected under the skin.	Last 6- 12 months. Repeating the injection is needed for long-term results.
Thread-lifting	Absorbable threads are inserted under the nasal skin.	Can last for 2 years.

Piezo rhinoplasty

Piezo or ultrasonic rhinoplasty is a relatively new rhinoplasty type. Piezo rhinoplasty does not use traditional nose surgery devices such as chisels, rasps, and hammers but an ultrasonic device called a Piezotome. 

In this type of nose job, they use high-frequency ultrasonic waves. These high-speed waves selectively work on bones and dense cartilage and leave the nasal soft tissues unharmed. This is because only the bones and thick cartilage tissue can absorb this kind of energy. The chosen rhinoplasty surgical approach for this type is the open approach, as the ultrasonic waves allow for very precise cutting and reshaping of the bones.

Since the skin and the underlying soft tissue are untouched during this type of surgery, there is less bruising and a shorter recovery time.

Rhinoplasty Techniques

Undoubtedly, one single surgical technique is not efficient for all types of rhinoplasty. The nasal skeleton differs from one person to another, and the techniques used for all patients can not be the same (3).

In addition to that, surgeons need to work on all parts of the nose separately to achieve the best outcomes. To shape each part of the nose according to what the patients require, different surgical techniques exist. Various rhinoplasty techniques are:

Nasal dorsum refinement

Patients with several bridge deformities such as a dorsal hump can benefit from techniques that reshape the dorsum of the nose. Dorsal hump removal maneuvers give the patients a smooth and fine dorsal bridge. Other nasal dorsum refinement techniques are augmentation and reduction of the nasal bridge. These techniques are among the most effective techniques in ethnic rhinoplasty.

Nasal tip refinement

Refining the nasal tip is a common request among patients. To reshape the tip of the nose, surgeons use maneuvers such as the nasal tip definition, nasal tip rotation, and reshaping the projection of the nose. Surgeons also refine the shapes of nostrils by reducing or enhancing their size.

Alar base reduction

Another technique in the rhinoplasty procedure is to alter the alar base. In patients with wide alar bases, surgeons use several surgical maneuvers to make the alar base smaller.

Septal deviation refinement

Septal deviation correction techniques have both cosmetic and functional significance. These techniques refine both asymmetry and breathing issues.

Grafting and implant techniques

Using grafts or implants, are important to create stability, strength, and beauty. The surgeons harvest the grafts from the nasal septum, ear, or rib cartilage. If an implant is required, they use different compatible materials to give the best cosmetic and functional outcome.

However, the techniques used for various kinds of rhinoplasty differ greatly according to several factors. The most important factors are:

Nasal structures: Surgeons use different techniques based on nasal structures. Most Asian and African American patients require augmentation rhinoplasty to increase length and projection. While, patients of Middle Eastern, Hispanic, or other races undergo reduction rhinoplasty to make their noses smaller. Grafts and implants are used for added stability

Patient’s requests: The patient shares their desired nose shape before surgery. If feasible, the surgeon uses proper techniques for a satisfactory outcome. Surgeons use tip refinement, dome, and suturing techniques to create a better-looking nasal tip. Alar base refinement is another popular procedure, altering nostrils and the base of the nose.

Surgeon’s preference: Rhinoplasty is a customized procedure for each individual. The doctor makes a specific surgical plan for every patient. As we mentioned earlier, choosing the correct rhinoplasty approach is a crucial step for your final nose shape. Your surgeon considers your facial balance and uses the best techniques to meet your aesthetic goals.