Refine nasal contours to achieve facial harmony.
Rhinoplasty changes nasal shape and can also improve breathing when structure is the problem. Whether correcting a structural issue for breathing or refining the cosmetic shape of the tip or bridge, we utilize precise, structural techniques to ensure a result that looks natural and functions perfectly.
InquireOpen rhinoplasty is the preferred approach for complex structural refinements, providing maximum exposure through a transcolumellar incision connected to bilateral marginal incisions. This allows direct visualization of the nasal skeleton for precise cartilage reshaping and grafting. Closed rhinoplasty, using only endonasal incisions, is reserved for cases requiring limited tip work or modest dorsal refinement. Dorsal humps are reduced using a combination of controlled osteotome rasping and septal cartilage management. Tip refinement uses suture techniques to refine and project the lower lateral cartilages, supplemented with structural grafts (shield graft, tip graft) when additional projection or definition is required. Lateral osteotomies narrow the nasal base. Septal work to correct deviation and harvest cartilage for grafting is performed concurrently.
Rhinoplasty is a good fit for adults with a fully developed nose who have clear cosmetic or breathing concerns they want corrected. Common concerns include a dorsal hump, nasal tip ptosis or bulbosity, wide nasal base, or asymmetry, as well as functional complaints such as nasal obstruction from septal deviation or turbinate hypertrophy. Psychological stability, clear goals, and the understanding that final rhinoplasty results require twelve months to fully manifest are essential attributes.
An external nasal splint is worn for seven to ten days. Significant periorbital bruising and nasal edema peak at three to five days and resolve substantially over two weeks. Splint removal and the appearance of an improved nasal shape at one to two weeks represent a meaningful milestone. Residual swelling, especially over the nasal tip, continues to resolve for six to twelve months. Contact sports and activities risking nasal trauma are restricted for three months.
Nasal splint worn. Significant periorbital bruising and swelling. Head elevation and cold compresses reduce edema. Breathing through mouth expected.
Splint removed. Bruising resolved or concealable. Return to work and social activities. Early nasal shape visible with residual swelling.
Nasal swelling continues to diminish monthly. Nasal tip refines progressively. Most social situations comfortable.
Final nasal shape fully apparent. Tip refinement complete. Skin fully draped over new structural framework.
Rhinoplasty has the highest revision rate among elective plastic surgery procedures, estimated at five to fifteen percent, due to the complexity of predicting healing and cartilage behavior. Risks include tip asymmetry, over-resection producing a pinched appearance, breathing changes, infection, and the rare complication of septal perforation. The columellar scar in open rhinoplasty is typically imperceptible but can be noticeable in patients with unfavorable healing. Structural grafting techniques that add rather than remove support have substantially reduced the risk of long-term deformity.
Non-surgical rhinoplasty using dermal fillers can camouflage dorsal irregularities, fill radix depressions, or refine tip projection temporarily. However, filler rhinoplasty cannot reduce a nasal hump, narrow the nasal base, or address functional breathing concerns. It is an appropriate temporary option for patients exploring rhinoplasty outcomes before committing to surgery, or for those with very specific, limited concerns.
Performed by Dr. Ruben Castro in Newport Beach, California