I find that the most common reasons why patients undergo nose reshaping surgery is for a “dorsal hump”, “bulbous tip”, “wide dorsum”; and now I am seeing more commonly in the Asian population “radix augmentation”. I find that more and more patients are coming to our practice because they want to make a significant change to the shape of their nose, which usually requires modification to many different aspects of the nose.
I also see many patients who come to us for rib graft rhinoplasty which we use to increase tip projection, augment the radix, and often straighten the nose for airway surgery with the use of spreader grafts. Almost invariably, the patient who wishes to modify the shape of their nose also has a problem with their airway. Typically, the maneuvers we use to improve the shape of the nose must also permit the flow of air through the nose so that the nasal function can be maintained.
As my aesthetic rhinoplasty practice continues to grow, I am finding that the parenthesis deformity of the lower lateral cartilages is quite common. Not only do the lower lateral cartilages need to be mobilized and returned to their anatomic position, but also the addition of lateral crural strut grafts can be quite helpful to increase tip definition.