The bone and cartilage of the nasal skeleton determine the shape of the nose. In simple terms, rhinoplasty involves separating the skin from the nasal skeleton, modifying the shape of the skeleton, and allowing the skin to re-drape over the refined shape.

Access to separate the skin from the skeleton is via incisions inside the nostrils. While the whole operation can be done with these incisions alone, more often than not these two incisions are joined with a small external incision across the columella (the bridge of skin that separates the nostrils). This allows a direct view of the skeletal structure and precise modification of its shape – so-called “open” rhinoplasty. The external scar is very inapparent.

In some cases only the tip cartilages need modifying, e.g. to correct a bulbous tip. Others may have an adequate tip but an ugly bridge line. If a prominent bridge line is to be lowered the nasal bones will have to be “in-fractured” (black eyes!). Commonly both tip and bridge line need refinement. 

Less often the tip or bridge line will need the addition of cartilage, bone or an implant.

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