Rhinoplasty is broad term to describe nasal reshaping but within the literature, patients will encounter a variety of different terms to describe the technique being employed and the goals of surgery. Broadly speaking, rhinoplasty is divided into two main types – open (external) or closed (endonasal) rhinoplasty. The additional descriptive terms listed below refer to the techniques used and goal of surgery:
- Open rhinoplasty – a small scar is made at the base of the nose between the nostrils in order to access the whole nasal framework
- Closed rhinoplasty – the incisions are all made internally in the nose with no external scars visible.
The choice of whether to have an open or closed rhinoplasty will depend on detailed discussion between the patient and the surgeon. It will largely be dictated by the extent of the deformity, the goals of surgery and surgeon experience to achieve the desired outcome. An open rhinoplasty affords far superior visualisation of the nasal skeleton and nasal tip but does leave a scar, albeit usually almost imperceptible. A closed rhinoplasty avoids a scar entirely and can have quicker healing times, especially if no tip work was carried out. However, the views are limited and major changes to the mid third of the nose and nasal tip are sometimes not possible.
Lately, rhinoplasty terminology has evolved to encompass additional techniques that are utilised by surgeons. These include:
- Preservation rhinoplasty – to reduce the nasal hump by pushing the nose into the face without directly removing the hump.
- Structural rhinoplasty – using cartilage grafting techniques to improve the shape of the nose and nasal tip
- Piezo (ultrasonic) rhinoplasty – using an ultrasonic instrument to sculpt the nasal bones as opposed to hand held rasps and osteotomes
- Hybrid rhinoplasty – employing a combination of the above techniques
Additional terms in the literature include:
- Functional rhinoplasty – surgery to improve the breathing. This typically incorporates deviated septum surgery in order to improve airflow or correcting nasal structures after trauma. This type of surgery usually needs an ENT surgeon skilled in facial plastic & reconstructive surgery.
- Cosmetic (aesthetic) rhinoplasty – surgery to improve the shape and appearance of the nose. This can include, changing the shape of the nostrils, removing a hump on the nose (dorsal hump), reshaping the nasal tip and a combination of all of the above.
- Revision rhinoplasty – this is where patients have had previous rhinoplasty surgery. Strictly if patients have had surgery elsewhere, it should be referred to as secondary rhinoplasty. Secondary surgery is not undertaken by everyone and this requires a particular expertise and level of experience. Frequently, grafting from the ear or rib is necessary.
- Ethnic rhinoplasty – this is not a term that is easy to define nowadays. Traditionally it has been a term coined in patients undergoing rhinoplasty who wish to preserve aspects of their ethnic heritage.
- Non-surgical (liquid) rhinoplasty – this is where cosmetic filler is injected to camouflage any irregularities of the nose or to smooth dorsal humps. It can be carried out after surgery as an adjunctive procedure or as an alternative to surgery altogether. It is a temporary intervention.
- Tip-plasty – surgery only to improve the shape of the nasal tip.
- Alarplasty (alar base reduction) – surgery to change the shape of the nostrils.
Whilst the above terms are commonly used in the literature, as a patient, rather than focus on the nomenclature, having a detailed discussion with your surgeon about your goals is more useful.
