Rhinoplasty (Nose Reshaping) | Operative planning

Open rhinoplasty uses a small cut between the nostrils and lifts the skin for wider visibility; closed rhinoplasty works through the nostrils. The choice is not a fixed list of deformities. It weighs how much tip support, graft placement, or revision anatomy must be seen against the extra dissection and swelling that wider exposure can bring. If a closed plan reveals a need for more access, it may be converted during surgery. Surgeon skill and your goals also matter; some noses need only profile changes, while others need tip work. The scar between the nostrils is usually small, but visibility and healing differ. Your surgeon judges these factors together.

Rhinoplasty changes bone and cartilage differently depending on the area treated. If the bridge is wide or humped, the side nasal bones may be broken and repositioned to narrow the nose. Cartilage may be removed, rearranged or supported with grafts. Dr. Purohit uses both open and closed approaches; open access uses an inverted-V or stair-step columellar incision. Nasal bones are reshaped with standard osteotomes, not piezo or ultrasonic instruments. Septal cartilage is the first-choice graft, ear cartilage is used rarely, and no synthetic implants are used. The septum is corrected in the same operation when needed, but turbinate surgery is not done, and better breathing is never promised.

Instead of the classic reduce-and-rebuild method, this approach keeps native structures intact, especially the keystone area, soft tissues and ligaments, and changes shape by remodelling rather than resection. It can be done open or closed, with careful dissection under the covering layer, and may mean less swelling and quicker early recovery in suitable cases. It is designed as a reduction primary rhinoplasty, so a nose that is already attractive but too raised or deviated may be a better candidate than one needing major rebuilding. It is not suitable for every nose. Dr. Vishal Purohit can assess whether your anatomy supports this philosophy and goals during consultation in Jaipur.

Rhinoplasty disrupts several major and minor tip-support mechanisms, and loss of support plus skin-soft-tissue contraction can let the tip drop over time. A stable nasal base helps counteract that settling over the first two years. Reduction also affects the bony and cartilaginous dorsum and tip, narrowing the nasal passage and decreasing airflow, especially on inspiration, so preserving the valves' intrinsic stiffness matters. Tip projection changes can influence external and internal nasal valves. The approach varies with anatomy, goals and surgeon judgment; open access gives better tip view but more swelling and longer recovery. Because Dr. Purohit does not perform functional nasal surgery, breathing complaints are referred for ENT assessment and better breathing is never promised.

Septal cartilage is preferred because it is straight, strong and available in the same operation. Ear cartilage is used rarely, often when softer or curved grafts are useful, such as filling or lower lateral cartilage work. Rib cartilage is chosen when a larger amount or longer, stronger support is needed, especially after previous surgery has used septal cartilage. In primary rhinoplasty, septal cartilage is often enough; in revision cases, rib or ear cartilage may be needed. Ear cartilage is mostly used for filling, while rib provides straight, strong grafts. No synthetic implants are used. The final choice depends on how much support or shape your nose needs.

Rib cartilage is useful when substantial structural support or dorsal augmentation is needed, because it provides ample material and rigid support. Harvesting it often requires an extra incision, often under the breast or along the chest wall, leaving a relatively short scar of about 5 cm. Other reported donor-site concerns include postoperative pain, temporary atelectasis, possible pneumothorax, chest wall deformity and calcification that can make carving harder, especially in older patients. The graft itself can warp or absorb moderately over time, so careful carving and fixation may reduce malposition. Synthetic implants avoid a donor site but carry different risks; autologous cartilage avoids disease transmission.

Alar base reduction narrows wide nostrils and the scar is placed in the nostril crease. A rim incision at the nostril margin is largely abandoned because it can cause predictable alar notching. Rhinoplasty is customized to your anatomy and goals, and both open and closed approaches may be used. Nostril size and shape can be changed significantly with appropriate techniques, but the plan and scar pattern vary. The scar may be straight, V-shaped or zigzag depending on the approach. Septal cartilage is the first-choice graft and ear cartilage is used rarely. Dr. Vishal Purohit can discuss realistic improvement and scar placement during consultation.

Planning starts with understanding whether the crookedness is bony, cartilaginous or both, and whether breathing is affected. The aim is a straighter-looking nose, a functional airway and aesthetic balance, but absolute correction can be difficult because bone and cartilage have memory and healing is unpredictable. Deviated bone may be repositioned with osteotomies, while cartilage is realigned; if midline correction is incomplete, the nose can drift back. A cartilage graft may camouflage a residual hollow. The septum is corrected in the same operation when needed, but breathing improvement is never promised and functional nasal surgery is not offered. Preoperative CT imaging helps define the deformity.

Septal cartilage is often preferred because it is accessible and usually strong, but its supply and quality vary. If a previous operation removed much cartilage, the remaining septum may not provide enough graft material, and a perforation can make revision dissection harder because flaps may adhere and support may be reduced. In such cases, surgeons may turn to ear or rib cartilage, or other graft materials, depending on the defect and plan. Revision findings can also be unpredictable, so the plan may need to adapt during surgery. In Dr. Purohit's confirmed practice, septal cartilage is the first choice, ear cartilage is used rarely, and no synthetic implants are used; this is a practice preference, not a universal rule.