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Rhinoplasty, Basic Closed Technique: Multimedia

Author: A John Vartanian, MD, Assistant Clinical Professor, Division of Head and Neck, Department of Surgery, University of California Los Angeles David Geffen School of Medicine; Instructor, Department of Otolaryngology-Head and Neck Surgery, University of Southern California Keck School of Medicine
Contributor Information and Disclosures

Updated: Aug 19, 2008

Multimedia

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Media file 1: Basic closed technique for rhinoplasty. Drawing illustrating marginal (inferior dotted line), cartilage-splitting (blue dotted line), and intercartilaginous (red dotted-line) endonasal incisions.

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Basic closed technique for rhinoplasty. Drawing illustrating marginal (inferior dotted line), cartilage-splitting (blue dotted line), and intercartilaginous (red dotted-line) endonasal incisions.

(Enlarge Image)

Media file 2: Basic closed technique for rhinoplasty. Endonasal incisions. Top dotted line marks the marginal incision, and the bottom incision marks the intercartilaginous incision. When combined, these 2 incisions permit the delivery of the alar cartilages outside the nose. Courtesy of A. John Vartanian, MD.

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Basic closed technique for rhinoplasty. Endonasal incisions. Top dotted line marks the marginal incision, and the bottom incision marks the intercartilaginous incision. When combined, these 2 incisions permit the delivery of the alar cartilages outside the nose. Courtesy of A. John Vartanian, MD.

(Enlarge Image)

Media file 3: Basic closed technique for rhinoplasty. Drawing illustrating septal incisions.

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Basic closed technique for rhinoplasty. Drawing illustrating septal incisions.

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Media file 4: Basic closed technique for rhinoplasty. Illustration underscoring the importance of leaving a robust (>15-mm) dorsocolumellar septal framework when performing septoplasty.

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Basic closed technique for rhinoplasty. Illustration underscoring the importance of leaving a robust (>15-mm) dorsocolumellar septal framework when performing septoplasty.

(Enlarge Image)

Media file 5: Basic closed technique for rhinoplasty. The caudal edge of the alar cartilages can be palpated with the back of the scalpel. Courtesy of A. John Vartanian, MD.

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Basic closed technique for rhinoplasty. The caudal edge of the alar cartilages can be palpated with the back of the scalpel. Courtesy of A. John Vartanian, MD.

(Enlarge Image)

Media file 6: Basic closed technique for rhinoplasty. Marginal incision made by gently scoring the vestibular skin with a sterile blade. Courtesy of A. John Vartanian, MD.

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Basic closed technique for rhinoplasty. Marginal incision made by gently scoring the vestibular skin with a sterile blade. Courtesy of A. John Vartanian, MD.

(Enlarge Image)

Media file 7: Basic closed technique for rhinoplasty. Drawing relevant anatomic landmarks on the patient's nose is helpful. Here, the alar cartilages are outlined, along with the tip-defining points, proposed area of cephalic resection, caudal border of the ascending process of the maxilla, osseocartilaginous junction, medial canthal line, and placement site for alar batten grafts. Courtesy of A. John Vartanian, MD.

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Basic closed technique for rhinoplasty. Drawing relevant anatomic landmarks on the patient's nose is helpful. Here, the alar cartilages are outlined, along with the tip-defining points, proposed area of cephalic resection, caudal border of the ascending process of the maxilla, osseocartilaginous junction, medial canthal line, and placement site for alar batten grafts. Courtesy of A. John Vartanian, MD.

(Enlarge Image)

Media file 8: Basic closed technique for rhinoplasty. Delivery of the alar cartilage can facilitate a number of maneuvers. An area of cephalic cartilage is marked for excision. The excision is performed at a slanting angle to prevent sharply demarcated edges. A minimum of 6-8 mm of alar cartilage is left behind. Courtesy of A. John Vartanian, MD.

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Basic closed technique for rhinoplasty. Delivery of the alar cartilage can facilitate a number of maneuvers. An area of cephalic cartilage is marked for excision. The excision is performed at a slanting angle to prevent sharply demarcated edges. A minimum of 6-8 mm of alar cartilage is left behind. Courtesy of A. John Vartanian, MD.

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Media file 9: Basic closed technique for rhinoplasty. Nasal base resection can narrow the interalar distance. A more lateral placement of the resection can also reduce alar flaring.

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Basic closed technique for rhinoplasty. Nasal base resection can narrow the interalar distance. A more lateral placement of the resection can also reduce alar flaring.

(Enlarge Image)

Media file 10: Basic closed technique for rhinoplasty. Most dorsal convexities (humps) have a substantial cartilaginous component. Cartilaginous dorsal excision is best performed with a sharp No. 15 blade.

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Basic closed technique for rhinoplasty. Most dorsal convexities (humps) have a substantial cartilaginous component. Cartilaginous dorsal excision is best performed with a sharp No. 15 blade.

(Enlarge Image)

Media file 11: Basic closed technique for rhinoplasty. Lateral intraoperative view of a patient demonstrating medial, lateral (black dots), and intermediate (blue dots) osteotomies. The relative location of the osteotomies is described in relation to the face (low) and the ceiling (high). Courtesy of A. John Vartanian, MD.

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Basic closed technique for rhinoplasty. Lateral intraoperative view of a patient demonstrating medial, lateral (black dots), and intermediate (blue dots) osteotomies. The relative location of the osteotomies is described in relation to the face (low) and the ceiling (high). Courtesy of A. John Vartanian, MD.

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References

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References

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Toriumi DM, Becker DG. Rhinoplasty Dissection Manual. Philadelphia, Pa: Lippincott Williams & Wilkins; 1999.
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Younger RA. The minimal rhinoplasty. Facial Plast Surg Clin North Am. Nov 2000;8(4):391-411.

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Keywords

rhinoplasty, osteotomy, septoplasty, rhinoplasty revision, nasal repair, nose surgery, nose job, cosmetic surgery, aesthetic nasal surgery, esthetic nasal surgery, endonasal rhinoplasty, closed rhinoplasty, nose reconstruction, nasal reconstruction, nasal tip sculpting, nasal base surgery, closed structure rhinoplasty, airway abnormalities, septal deformity, septal perforation, nasal augmentation, bifid nasal tip, nasal hump, stair-step deformity, stair step deformity, saddle-nose deformity, saddle nose deformity, polly beak deformity, polly-beak deformity, open roof deformity, plastic surgery

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Contributor Information and Disclosures

Author

A John Vartanian, MD, Assistant Clinical Professor, Division of Head and Neck, Department of Surgery, University of California Los Angeles David Geffen School of Medicine; Instructor, Department of Otolaryngology-Head and Neck Surgery, University of Southern California Keck School of Medicine
A John Vartanian, MD is a member of the following medical societies: American Academy of Facial Plastic and Reconstructive Surgery, American Academy of Otolaryngology-Head and Neck Surgery, and American Medical Association
Disclosure: Nothing to disclose.

Medical Editor

Frederick J Menick, MD, Clinical Associate Professor, Department of Surgery, Division of Plastic Surgery, University of Arizona College of Medicine; Private Practice in Tucson, Arizona
Frederick J Menick, MD is a member of the following medical societies: American Association of Plastic Surgeons, American Society for Aesthetic Plastic Surgery, American Society of Plastic and Reconstructive Surgery, American Society of Plastic Surgeons, and Canadian Society of Plastic Surgeons
Disclosure: none None None

Pharmacy Editor

Francisco Talavera, PharmD, PhD, Senior Pharmacy Editor, eMedicine
Disclosure: Nothing to disclose.

Managing Editor

George Peck, Jr, MD, Consulting Staff, Department of Plastic Surgery, St Barnabas Hospital of New Jersey
George Peck, Jr, MD is a member of the following medical societies: American Society for Aesthetic Plastic Surgery
Disclosure: Nothing to disclose.

CME Editor

Nicolas (Nick) G Slenkovich, MD, Practice Director, Colorado Plastic Surgery Center at Swedish Medical Center
Nicolas (Nick) G Slenkovich, MD is a member of the following medical societies: American Academy of Otolaryngology-Head and Neck Surgery, American Medical Association, American Society of Plastic Surgeons, and Colorado Medical Society
Disclosure: Nothing to disclose.

Chief Editor

Deepak Narayan, MD, FRCS, Associate Professor of Surgery (Plastic), Yale University School of Medicine; Chief of Plastic Surgery, West Haven Veterans Affairs Medical Center
Deepak Narayan, MD, FRCS is a member of the following medical societies: American Association for the Advancement of Science, American College of Surgeons, American Medical Association, American Society of Maxillofacial Surgeons, American Society of Plastic Surgeons, Indian Medical Association, Plastic Surgery Research Council, Royal College of Surgeons of Edinburgh, and Royal College of Surgeons of England
Disclosure: Nothing to disclose.

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eMedicine Specialties > Plastic Surgery > Nose

Rhinoplasty, Basic Closed Technique: Multimedia

Multimedia

Basic closed technique for rhinoplasty. Drawing illustrating marginal (inferior dotted line), cartilage-splitting (blue dotted line), and intercartilaginous (red dotted-line) endonasal incisions.

Basic closed technique for rhinoplasty. Endonasal incisions. Top dotted line marks the marginal incision, and the bottom incision marks the intercartilaginous incision. When combined, these 2 incisions permit the delivery of the alar cartilages outside the nose. Courtesy of A. John Vartanian, MD.

Basic closed technique for rhinoplasty. Drawing illustrating septal incisions.

Basic closed technique for rhinoplasty. Illustration underscoring the importance of leaving a robust (>15-mm) dorsocolumellar septal framework when performing septoplasty.

Basic closed technique for rhinoplasty. The caudal edge of the alar cartilages can be palpated with the back of the scalpel. Courtesy of A. John Vartanian, MD.

Basic closed technique for rhinoplasty. Marginal incision made by gently scoring the vestibular skin with a sterile blade. Courtesy of A. John Vartanian, MD.

Basic closed technique for rhinoplasty. Nasal base resection can narrow the interalar distance. A more lateral placement of the resection can also reduce alar flaring.

Basic closed technique for rhinoplasty. Most dorsal convexities (humps) have a substantial cartilaginous component. Cartilaginous dorsal excision is best performed with a sharp No. 15 blade.

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References

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Keywords

Contributor Information and Disclosures

Author

Medical Editor

Pharmacy Editor

Managing Editor

CME Editor

Chief Editor