Rhinoplasty involves modifying the nasal skeleton of bone and cartilage to alter the shape of the nose. Occasionally reduction of excess skin is also done at the base of the nose. Rhinoplasty can be done as an open or closed procedure depending upon the changes that need to be made.
An open rhinoplasty is particularly useful for changing the contour of the tip of the nose when direct visualisation of the cartilages which form the nasal tip, can be achieved. It is then easier to adjust their position, reshape them, or augment them with cartilage grafts. The disadvantage of an open rhinoplasty is that it leaves an external scar and the tip of the nose tends to be more swollen for longer after surgery.
A closed rhinoplasty is done entirely through incisions inside the nose without any visible incisions except a very small puncture wound on the side of the nose which virtually disappears.
During a rhinoplasty the bone and cartilage framework of the nose is reduced and reshaped. This usually involves removing excess from the back of the nose to reduce a prominent hump. The nose is then narrowed by perforating the nasal bones through a small stab incision using a chisel and fracturing them to move them closer.
The procedure is then completed by reshaping the tip cartilages to narrow the tip and the tip can then be repositioned by either setting it further back or higher depending upon the aesthetic goals of the nose that are required.