Rhinoplasty is a popular yet challenging procedure in facial plastic surgery, with trends in nose shape evolving over the years. Improvements in techniques and technology have influenced these changes in part. Many of the differences we have incorporated, however, are the result of an understanding by both surgeons and patients that best results are obtained when the desired result is determined by creating a nasal shape which is most harmonious with the patient’s other facial features. There’s also a growing preference for maintaining ethnic characteristics during nose reshaping. Together these trends have resulted in a wider variety of aesthetically pleasing results tailored to each patient’s ideal outcome.
In the 60s and 70s, rhinoplasties often aimed for a nasal shape based on European ideals, focusing on a narrow tip and low, sometimes even concave, nasal dorsum. For many patients with thin skin and a dorsal hump, this type of reductive approach gave a nice aesthetic result. However, these techniques didn’t always suit patients with thicker skin, weaker cartilage, or a desire to maintain nasal prominence. Over time, surgical techniques improved to provide greater tip support and reinforcement of nasal architecture, with the open approach becoming more popular for easier placement of structural grafts.
Modern rhinoplasty emphasizes facial balance, enhancing the natural beauty of other features, particularly the eyes and mouth. Preferences now lean towards higher nasal dorsums with straighter lines. Reorienting tip cartilages for more projection and a sculpted appearance is often crucial. This may be particularly important in patients who desire maintenance of ethnic character to their nose, where older maneuvers to narrow the tip may provoke instability in already weak cartilage. Reshaping and reinforcing tip cartilages can also improve external valve support and breathing while providing a better result.
The resurgence of preservation techniques in rhinoplasty is also significant. These techniques, first described a century ago, aim to alter the nasal dorsum from beneath, preserving the natural structure of the dorsal aesthetic lines. Modern instruments like ultrasonic osteotomies and the use of endoscopes to visualize the nasal septum created a variety of dorsum lowering options. These advancements in the preservation technique offer less bruising, minimal swelling, and faster healing times.
With the variety of rhinoplasty approaches available today, customization is more achievable than ever. Patients and surgeons recognize the importance of maintaining facial balance by tailoring each procedure to fit the individual’s features and goals, moving away from creating similar “ideal” noses repeatedly.
