Common Rhinoplasty Techniques in Australia: Functional, Cosmetic, and Reconstructive Approaches

Rhinoplasty is a surgical procedure that can alter the shape of the nose while also addressing breathing or functional issues. Different techniques are available, and the most suitable approach depends on individual anatomy, goals, and long-term safety. This article outlines common rhinoplasty techniques used by plastic surgeons in Australia, highlighting both cosmetic and functional aspects. It is written to help patients better understand their options and to support informed decision-making.

Open vs Closed Rhinoplasty Techniques

Open Rhinoplasty: Involves a small incision on the columella (the tissue between the nostrils). It provides greater visibility and access for the surgeon, making it useful for complex cases requiring detailed reshaping. Recovery may involve more swelling at first due to the external incision.

Closed Rhinoplasty: All incisions are placed inside the nostrils, leaving no external scar. It is usually chosen for less extensive changes. Recovery may be faster, but visibility is more limited.

Patient perspective: Both approaches can achieve good outcomes. The choice depends on the complexity of changes needed and the surgeon’s recommendation.

Osteotomy Rhinoplasty Techniques (Bone Reshaping)

When reshaping nasal bones, surgeons may use conventional instruments or ultrasonic (piezo) devices. Recent systematic reviews suggest ultrasonic instruments can reduce early bruising and swelling, though long-term outcomes are similar. The choice depends on anatomy, goals, and surgeon preference.

Functional Rhinoplasty Techniques

Functional rhinoplasty focuses on improving airflow through the nose. Common conditions and techniques include:

• Weakness or narrowing of the external nasal valves – often treated with alar batten grafts or lateral wall reinforcement.
• Constriction inside the nasal cavity (internal valves) – addressed with spreader grafts or flaps to support the internal nasal valve.
• Septal deviation (a displaced nasal septum) – corrected with septoplasty to improve the central airway.
• Enlarged turbinates (swollen nasal tissues) – managed with conservative turbinate reduction to enhance airflow while preserving function.

Patient perspective: These procedures are often combined to improve breathing comfort and prevent long-term obstruction.

Cosmetic Rhinoplasty Techniques and Variations

Cosmetic rhinoplasty aims to adjust nasal features to better harmonise with the rest of the face. Modern approaches emphasise natural-looking results that respect the patient’s facial proportions, rather than following trends. Suitability depends on anatomy and healing potential, and subtle changes are often more enduring than dramatic ones. Techniques and the concerns they can address include:

Dorsal hump reduction

Smooths a hump on the bridge using traditional reduction or preservation methods:

• Structural rhinoplasty (reshaping and grafting) – straighten or balance a crooked or asymmetrical nose, often reinforcing the nasal framework for long-term support.
• Preservation rhinoplasty techniques – maintain natural anatomy while refining shape, often using push-down or let-down approaches for dorsal humps in suitable patients.

Nasal dorsum augmentation

Options include:

• Autologous cartilage grafts (from septum, ear, or rib) – used to build height and projection with natural tissue integration.
• Rib cartilage (solid or diced in fascia) – provides strong support when larger augmentation is required, though donor site discomfort or scarring can occur.
• Synthetic implants – man-made materials, occasionally used in select cases where patient tissue is not available.

Nasal tip refinement and alar base procedures

Options include:

• Cartilage reshaping, cephalic trim, or suture techniques – refine a bulbous or drooping tip.
• Alarplasty – narrows wide or flared nostrils for improved proportion.
• Columella strut grafts – support tip definition and stability.
• Tongue-in-groove or septal extension grafts = provide precise control of tip projection and rotation.
• Shield or onlay tip grafts – add definition in selected cases, particularly in thicker skin types.

3D photography and simulation may be used to support planning and communication. These tools are illustrative only and cannot predict exact results. Long-term satisfaction is measured by both function and patient-reported outcomes, not images alone.

NEW TRENDS IN RHINOPLASTY: PRESERVATION VS. STRUCTURAL APPROACH

Rhinoplasty Risks and Limitations

As with all surgery, rhinoplasty carries risks. These may include bleeding, infection, scarring, persistent swelling, or breathing difficulties. Specific techniques have their own limitations, for example, implants or cartilage may shift, and rib cartilage harvest involves a separate donor site. Outcomes vary between individuals, and no procedure can guarantee perfection. A careful consultation ensures that risks are weighed against expected benefits.

Rhinoplasty involves a range of surgical techniques that can address both cosmetic and functional concerns. The right approach depends on individual anatomy, goals, and long-term considerations. Consultation with a qualified plastic surgeon (FRACS) is essential to determine the safest and most appropriate method.

Rhinoplasty