The philosophy of corrective and aesthetic surgery of the external nose has evolved over the last several decades. Historically, facial plastic surgeons had a limited understanding of nasal structure and of the long-term effects of wound healing. Often, immediate postoperative results were cosmetically pleasing, but the structural integrity of the nose was lost. In some cases, structurally compromised noses collapsed on inspiration, leading to nasal blockage. During the healing process, the skin tightened and often buckled this weakened framework, leading to asymmetries and deformities. Over the last few decades facial plastic surgeons have leveraged advancements in the understanding of wound healing and nasal structure to develop improved tissue rearrangement techniques. When coupled with structural reinforcement, these new techniques can be performed to maintain or improve nasal respiratory function, ensure long-lasting structural stability, and achieve an aesthetically pleasing cosmetic result. This discussion describes some of the new techniques.
Rhinoplasty is considered one of the most challenging of all plastic surgery procedures. When the procedure is properly performed, the surgeon repositions the nasal framework to alter esthetic contours and to maintain or improve respiratory function. In the 1930s the most popular type of rhinoplasty was the Joseph reductive rhinoplasty. Although this technique typically produced cosmetically favorable immediate postoperative results, it often damaged the structural integrity of the nose and caused patients to develop functional disturbances years later. In addition, during the healing process, as the tissues contracted over this weakened nasal structure, patients frequently developed cosmetic deformities and asymmetries. Despite these issues, this model of the reductive rhinoplasty technique continues to be performed in many centers as the preferred method even to this day.