We may perform rhinoplasty by an open or closed approach. In the former, a small cut is made in the skin bridge between the nostrils, known as the 'columella'. This allows excellent access to the bone and cartilages of the nose so that they can be altered as required under direct vision. Following the procedure, the skin is redraped and the cut is closed. This will leave a small scar, usually well hidden. In some circumstances it may not be necessary to open the nose fully, and sufficient access can be achieved through small incisions inside the nostrils. This eliminates any external scar.
To straighten the nose or reduce its size, the bony 'bridge' or roof is cut or rasped down to a predetermined level. The bony side-walls of the upper nose must normally be fractured in a controlled way, to bring them back together again to form a new, lower, straighter roof. The nose can be shortened and reshaped by sculpting the cartilage which forms the lower half and tip of the nose. If the nostrils are too wide or long, they may need to be narrowed.
Some noses are too small rather than too big, and they may have a saddle deformity that needs to be augmented. The tip too may need augmentation. Natural or artificial materials are used to build up a flattened or misshapen nose. Natural materials include cartilage or bone from your ear, nasal septum or ribs, for example, and these have a lower complication rate than foreign materials.
The septum is the cartilaginous layer that divides the internal nasal airway into two sides. This may be deviated as a result of previous injury and may contribute to breathing difficulties as well as asymmetry of the nose. A septoplasty aims to correct septal deformities and may be combined with the rhinoplasty.