This review article will highlight several fundamental principles and advances in rhinoplasty. Nasal analysis has become more sophisticated and thorough in terms of breaking down the anomaly and identifying the anatomic etiology. Performing this analysis in a systematic manner each time helps refine these skills and is a prerequisite to sound surgical planning. Dorsal augmentation with alloplastic materials continue to be used but more conservatively and often mixed with autogenous grafts. Long term outcomes have also taught us much with regards to wound healing and soft tissue contracture. This is best demonstrated with a hump reduction where the progressive pinching at the middle vault creates both aesthetic and functional problems. Correcting the twisted nose is challenging and requires a more aggressive intervention than previously thought. Both cartilage and soft tissue appear to have a degree of memory that predispose to recurrent deviations. A complete structural breakdown and destabilization may be warranted before the nose is realigned. This must be followed by careful and meticulous restabilization. Tip refinement is a common request but no single maneuver can be universally applied; multiple techniques and grafts must be within the surgeon's armamentarium.
Cartilage ; Contracture ; Memory ; Nose ; Rhinoplasty ; Transplants ; Wound Healing

Nasal restoration in the 21st century has reached a new milestone that has brought together centuries of experiences, lessons, errors, and rewards. The bar has been set and it is nothing less than a restoration of normal function and complete social acceptance. The aesthetic expectations of both minor and major nasal repair include symmetry, natural contour, excellent color and texture match, and a final product that remains inconspicuous to the casual observer. The major tenets that have been realized today include the wide application of the subunit principle, liberal and nonanatomic cartilage grafting (for form and function), and addressing each of the three layers of the nose independently. Anticipating resultant scars and vectors of tension during wound healing are the subtle nuances of nasal reconstruction that ensure a pleasing result. The robust nature of the forehead flap has proven to be a workhorse for major nasal resurfacing.
Cartilage ; Cicatrix ; Dietary Sucrose ; Forehead ; Nose ; Reward ; Social Distance ; Transplants ; Wound Healing

Nasal restoration in the 21st century has reached a new milestone that has brought together centuries of experiences, lessons, errors, and rewards. The bar has been set and it is nothing less than a restoration of normal function and complete social acceptance. The aesthetic expectations of both minor and major nasal repair include symmetry, natural contour, excellent color and texture match, and a final product that remains inconspicuous to the casual observer. The major tenets that have been realized today include the wide application of the subunit principle, liberal and nonanatomic cartilage grafting (for form and function), and addressing each of the three layers of the nose independently. Anticipating resultant scars and vectors of tension during wound healing are the subtle nuances of nasal reconstruction that ensure a pleasing result. The robust nature of the forehead flap has proven to be a workhorse for major nasal resurfacing.
Cartilage ; Cicatrix ; Dietary Sucrose ; Forehead ; Nose ; Reward ; Social Distance ; Transplants ; Wound Healing