Nasal Reconstruction and Aesthetic Rhinoplasty

Abstract

The nose is one of the most prominent features on the human face, and rhinoplasty has preoccupied surgeons for centuries. The nose is often divided into thirds, each third has its own features. Nasal analysis begins with a frank discussion with the patient and includes a thorough history taking, including prior surgeries and any drug use. Analysis of the nose consists of the relationship of the nose to the face in the facial horizontal thirds, vertical fifths, and facial angles. It also includes an assessment of harmony between the nasal segments, nasal length, tip shape, projection, and rotation, and the alar-columellar relationship. Deformities of the upper vault include a dorsal hump, which is treated with rasping and occasionally block resection, or dorsal deficiency, which is treated with grafts. The tip can be modified by grafts, resection of alar cartilages, or suture placement. Nasal deviation must be localized to the upper, middle, or lower vault and is treated with either osteotomies for the upper vault or cartilaginous repositioning for the middle and lower vaults. All rhinoplasties require thoughtful planning and preoperative customization.