Beneath every line we see on the surface of the nose lies a supporting structure. I approach structural rhinoplasty as a method of identifying where this support is lacking and planning both the shape and the structural integrity of the nose accordingly.
Structural rhinoplasty aims to adjust the supportive relationships within the nose’s bony and cartilaginous framework. This does not mean placing the same number of grafts in every patient. It is necessary to utilize the existing structure where it is sufficient and to provide additional support where it is inadequate.
The shapes of the nose as seen from the front, side, and bottom are not independent of one another. The position of the tip of the nose, the balance of the nostrils, and the width of the bridge are different perspectives of the same structural system. For this reason, I do not reduce the planning process solely to the profile line.
In the article on facial aesthetics that my colleagues and I published in 2013, we analyzed the surface of the nose using polygons. This analysis allows me to think more clearly about which surfaces need to be modified and how, rather than simply describing the shape using general terms like “bridge” or “tip.” [1]
It is not always necessary to remove tissue from a specific area to correct a surface-level defect. The surface may also change when the orientation or support of the underlying cartilage changes. I want the surgical plan to link the visible problem with the underlying anatomical cause.
The definition of the tip of the nose does not, by itself, mean that it is pointed. The two sides of the tip, the alar rims, the columella, and the area where they meet the bridge of the nose form a single unit. While enhancing one feature, it is also necessary to maintain the balance of the surrounding areas.
Our study, “Surface Aesthetics in Tip Rhinoplasty,” examines the surface of the nasal tip in conjunction with the positioning of the cartilages and support techniques. From my perspective, the contribution of the polygonal approach to structural surgery is that it makes it clear which anatomical arrangement will support the targeted surface. [2]
Cartilage grafts are important tools; however, sutures, repositioning of existing cartilage, and soft tissue relationships can also be incorporated into the support plan. The choice of which tool to use is determined by the location of the problem to be corrected and the nature of the existing tissue.
The study on neo-interdomal suturing that we published with Alper Eskalen serves as an example of the relationship between soft tissue and sutures in tip support. This retrospective technical series describes a specific approach; it does not imply that the graft will be used in all noses or that it is superior to other methods. [3]
I assess whether a nose looks natural based not so much on the name of the technique used, but rather on how it relates to the other parts of the face. The balance between the forehead, lips, chin, and tip of the nose is important. Structural support does not have to create a harsh appearance on the surface; the purpose of the plan is not to make the support visible, but to achieve the desired shape.
Skin thickness and the strength of the existing cartilage are also factors in this plan. Minor surface irregularities may be more noticeable in thin skin; in thicker skin, however, the way the shape is projected outward differs. These characteristics are discussed together during the consultation.
Structural and reconstructive techniques are not two separate categories that are chosen before surgery and cannot be altered afterward. In one nose, the bridge can be preserved while the tip support is reworked. In another nose, priority may be given to preserving the ligaments while a specific area requires reconstruction.
For this reason, the plan I recommend to the patient is based not on technical considerations but on anatomical rationale. Explaining where support is needed, where the existing structure is sufficient, and what limitations each modification entails is just as important as the surgery itself.
You can access the relevant publications and book chapters via the links below. The scope of the studies and the applicability of each technique should be evaluated on a case-by-case basis.
Barış Çakır, Teoman Doğan, Ali Rıza Öreroğlu, Rollin K. Daniel · co-authored article
Barış Çakır, Ali Rıza Öreroğlu, Rollin K. Daniel · co-authored article
Alper Eskalen and Barış Çakır · co-authored article
A treatment plan is developed by taking into account your nasal anatomy, your breathing difficulties, and your expectations.
Frequently Asked Questions About Structural Rhinoplasty.
This approach involves adjusting the relationships between the supporting bones and cartilage of the nose and, when necessary, reconstructing the supporting structures. It is not a single surgical procedure in which the same steps are performed on every patient.
No. The extent of support required is determined by evaluating the existing septal cartilage and any previous surgeries. Rib cartilage may be an option; it is neither the only nor the mandatory option.
The presence of a graft alone does not determine its appearance. Its location, size, the surrounding structures, and the overlying skin are important. The goal is a shape that harmonizes with the face and provides adequate support.
Yes. The open or closed approach determines the access route. The choice of which approach to use for structural supports depends on the anatomy, the planned procedures, and the surgical assessment.
Polygons are a tool for surface analysis and planning. Structural techniques, on the other hand, are surgical tools that can be used to achieve this goal. Analysis and application complement each other.
No. Management of existing cartilage, suturing techniques, and soft tissue relationships can also be incorporated into the plan. The choice of which instrument will be sufficient is determined based on the patient’s anatomy.
If structures affecting the airway are evaluated and included in the plan, they can also be used for this purpose. However, the source or solution to a breathing problem cannot be determined based solely on the shape of the nose.
There is no single, universally superior method that applies to everyone. Some noses require preservation, while others require reconstruction. The tools for both approaches can be used together in the same surgery.
You can request an appointment to discuss your personal expectations and options.