In addition to rhinoplasty, some teenagers and young adults are having chin augmentation to balance out a profile or add “strength” to the lower face, as well as cheek augmentation to widen an overly narrow face. Other procedures, such as removing fat from the lower eyelids or cheeks and raising congenitally low eyebrows, are also occasionally being performed.
Unfortunately, when too many procedures are performed, especially if done incorrectly or not conservatively, the effect can be to lose the subtle beauty of youth and produce a result that may seem unnatural.

   When we evaluate nasal symmetry, we first check to see the overall facial symmetry. Since the root of the nose starts between the eyebrows and the base of the nose ends over Cupid’s bow of the upper lip, it would be impossible to straighten a nose if the centers of these two landmarks were not directly in line. However, through differential cartilage grafting, we can give the illusion of a straighter nose. Next we evaluate the upper, middle and lower thirds of the nose. The upper third is generally bony and can be straightened via various fracturing techniques. The middle third is mostly cartilaginous and may require cartilage repositioning, resecting or grafting. And, finally, the lower third involves the cartilage and soft tissue of the nasal tip and nostrils— either of which can be asymmetric or unequal.

There are numerous techniques for addressing deformities of these nasal structures. The tip cartilages can be equalized and re-positioned, if necessary, and the nostrils can be made more equivalent through techniques that raise or lower the rims and narrow or expand the openings.

The main difference is an incision between the nostrils which allows for skin elevation off the underlying bony-cartilaginous framework. It is the technique most often employed when access through the top of the nose, as well as through the nostrils, is desirable. By providing this greater degree of visualization, asymmetries are more easily evaluated and graft placement and fixation are more exact. Finally, dissection through intensely scarred areas within the nose from prior surgery or trauma is  made easier.

For female patients, we aim to produce a very gentle slope over the bridge of the nose, ending in a defined tip which is the highpoint on profile. Additionally, the sidewalls of the nose are somewhat narrower in the midsection, producing a subtle curve or “C” shape. Extending this curve into the eyebrow produces a continuous  convexity. Furthermore, the angle between the bottom of the nose and the upper lip is greater than 90 degrees or a right angle. In some cases, it may be as large as 105-110 degrees, producing more “nostril show” than we see in a man.

On the other hand, the angle for a man is around 90 degrees. The bridge tends to be straighter, which forms a “T” with the straight eyebrows above it. And we are generally more accepting of slight imperfections and a larger framework in a man.

“Rhinoplasty” is the term we use to describe an operation that changes the appearance of the nose. When used in the context of improving breathing, it suggests a deformity that, by itself, is blocking airflow, as with a collapse of a sidewall or a deformity that contributes to the deviated septum, as may be seen in a nasal injury where deflected nasal bones are holding the septum in a displaced position. Hence, the term “septorhinoplasty”.

1-      The nostril is too wide or flared, with the long axis in a horizontal rather than a vertical direction.

2-      The nostril is too narrow.

3-      There is a notch or retraction along the superior border.

4-      There is an overhang of tissue along the superior border

There are several approaches to each of these deformities, and these are usually performed at the conclusion of the operation..

In most instances, their desire is to have features that more closely resemble the Western European ideals. However, one must be careful to preserve elements of the patient’s heritage so as to avoid a possible disharmony with the remaining features when performing a rhinoplasty surgery.

In general, one must approach each patient individually so as to determine how much of a change they desire. In the African and Asian patients, and to a lesser degree the Latino patients, the bridge usually needs to be augmented. This is most commonly accomplished using nasal septal, ear or rib cartilage which is diced and placed within a rolled covering of fascia taken from the temple. Although, in rare instances, a synthetic material like Gore-tex may be used. Also, because the skin in each of these ethnicities is usually thick, the nasal tip needs augmenting to produce a more projected, angular appearance. Once again, cartilage is used, in the form of a rigid strut placed between the nostrils. And finally, the nostrils have to be addressed. Though projecting the nasal tip may bring the nostrils in slightly, an additional procedure such as excising tissue or narrowing with cinching sutures may be needed.