While it may be inaccurate to categorize rhinoplasties strictly, here is a classification for easy understanding. They may not be mutually exclusive, but they do give an overall picture of the wide variety in rhinoplasty surgery.
Reduction Rhinoplasty: Augmentation or Reduction Rhinoplasty
Many rhinoplasty techniques fall into two basic categories: reduction rhinoplasty and augmentation rhinoplasty. Whereas augmentation rhinoplasty augments or adds to the nose, reduction rhinoplasty reduces it. Patients may be interested in making the overall appearance of the nose smaller or reducing specific areas of the nose like a hump or bump on the bridge or a large nasal tip. Cartilage and/or bone may be removed or rearranged to create the desired shape.
Refinement rhinoplasty often refers to tip refinement techniques designed to refine and add more definition to a bulbous, bulky or drooping nasal tip. This is a common request among patients of ethnicity as well as in patients whose nose has become bulbous or droopy with age. Refinement rhinoplasty may also refer to other techniques designed to achieve a smaller, more refined looking nose, including hump reduction, tip rotation, and alar base reduction.
Revision rhinoplasty refers to secondary procedures which repair the form and/or function of the nose following a previous rhinoplasty surgery. Rhinoplasty is one of the most complicated cosmetic surgery procedures to perform and, as such, has one of the highest revision rates. Complications may occur following a primary rhinoplasty due to surgical error or healing complications. In some cases, patients have experienced insufficient improvement, for instance a residual hump may need further removal; in other cases, too much tissue may have been removed from the nose, resulting in deformity. Fortunately,revision rhinoplasty can often provide dramatic improvement for individuals who are unhappy with the results of their prior nose surgery.
Reconstructive rhinoplasty is a procedure designed to rebuild a nose that is partly or entirely missing. The nose may be destroyed through trauma or cancer. Techniques to rebuild the nose often involve the use of cartilage grafts and skin flaps. In some cases, multiple operative stages may be required.
Ethnic rhinoplasty refers to rhinoplasty procedures performed on patients of ethnicity, including patients of African American, Asian, Hispanic and Middle Eastern descent. With ethnic rhinoplasty, the goal is typically to improve the form and function of the nose while still retaining the patient’s sense of ethnicity. A good ethnic rhinoplasty surgeon must have extensive experience with and an understanding of the nasal anatomy and shape of noses in all ethnicities.
The goal of any surgery should not be to change the ethnic appearance of a person, but rather to enhance the attractive features of the face. In patients, this involves subtle changes of the nose to provide more emphasis on the patient’s eyes rather than the nose.
Indian noses vary significantly from person to person. Some patients have thick skin and underprojecting (noses which do not stick far enough from the face). These nose require augmentation with cartilage grafting to provide more definition to the nasal tip and remove the bottom heavy appearance of the nose.
Some Indian noses have thinner skin and are overprojected (stick out too far from the face), and these noses must be placed closer to the face. The most difficult Indian nose is that which consists of thick skin and is overprojecting. Many surgeons wrongfully attempt to treat these noses similar to a Caucasian nose and resect cartilage. The problem is that the extra skin has no place to contract and may in fact look rounder and more bulbous after surgery. These patients require a special balance of projection to provide adequate nasal tip projection and conservative supratip thinning of the subcutaneous tissues. This subset of patients requires frequent follow-up and may require steroid injections to prevent scar formation.
The bridge of the nose should vary from patient to patient and depends on their other facial features. A petite female will often look better with a lower bridge of her nose, depending on her forehead shape and facial shape and length. A taller male will require a higher, stronger dorsum.
It is important to create a nose which works harmoniously with the face.
Adolescence can be a particularly trying time when it comes to self image. It’s not surprising then that many teens desire rhinoplasty. In most cases, however, it’s advised that surgery be postponed until the nose has completed its growth spurt, which tends to occur around 15 or 16 years of age in girls and a little later in boys. Exceptions are sometimes made, particularly in cases where trauma has occurred to the nose, however it must be understood that continued growth of the nose may negatively impact the results, necessitating additional surgery in the future. Not only must teens be physically prepared for surgery, they must also be emotionally ready to handle the surgery and recovery and understand that the changes made to the nose are permanent.
Many individuals are surprised to find that as they get older, aging not only affects the appearance of their skin and face but their nose as well. Though growth of the nose is generally complete around age 16, the shape of the nose may continue to change with age. Common aging changes include elongation and drooping of the tip, narrowing of the sidewalls, and thickened nasal skin. Breathing complications may also develop over time. Rhinoplasty can improve many of the unwanted changes that occur in the nose with age, restoring a more youthful and pleasing appearance.