DOI : 10.17577/Structural analysis plays a central role in modern nasal surgery. By understanding and applying the biomechanical properties of nasal anatomy, we are able to design surgical interventions that are not only aesthetically pleasing but also durable and functionally sound. This article explores how structural analysis principles are used to advance rhinoplasty techniques, especially in anatomically challenging cases such as those involving Southeast Asian nasal features.
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The Septum as the Central Support System
The nasal septum serves as the primary structural component of the nasal framework. It is both the foundation and the anchor around which nasal reshaping is performed.
- The septum provides the central axis of nasal support.
- It is often used to harvest cartilage for structural grafts.
- A 10mm dorsal and caudal strut is typically preserved for core stability.
- Harvested cartilage is shaped into septal extension grafts (SEGs) to define the nasal tip.
A strong septal foundation leads to a nose that holds its shape over time, resists collapse, and maintains symmetry and projection.
Reconstructing the Tip Using Structural Analysis
Tip refinement is often the most noticeable part of rhinoplasty. Through structural analysis, we assess the strength, angle, and resilience of the lower lateral cartilages (LLCs), as well as the thickness of the soft tissue envelope.
Tip Projection and Shape Correction:
- Cephalic trim is used for reducing a bulbous appearance but must be done conservatively.
- Domal sutures refine the tip by bringing the medial and lateral components closer together.
- Shield grafts and columellar struts enhance tip definition and support.
- Septal extension grafts (SEGs) control both projection and rotation of the tip.
Tip refinement benefits from repeated assessment and layered support to ensure long-term success. Projection and elongation are frequently necessary in Southeast Asian noses.
For patients seeking refined results that address both aesthetics and structure, considering a nose job in Los Angeles provides access to advanced techniques that emphasise both precision and long-term durability.
Grafting Techniques: Structural Balance and Harmony
We rely on precise grafting to re-establish or enhance the nasal framework. Each graft plays a specific role in reshaping or stabilising the nose.
- Spreader grafts correct internal valve narrowing and dorsal deviation.
- Extended spreader grafts are useful for tip rotation and nasal elongation.
- Dorsal onlay grafts provide smooth contour and aesthetic enhancement.
- Conchal cartilage is used when septal supply is limited, particularly for secondary refinement.
These grafts, when positioned with structural intent, ensure long-lasting outcomes. The nose must be not only beautiful but also strong, symmetrical, and resilient.
Unique Anatomical Features of Southeast Asian Noses
Southeast Asian noses pose specific anatomical challenges. Structural analysis helps surgeons navigate these features with greater precision.
- Short and low dorsum: Often requiring dorsal augmentation.
- Thick soft tissue envelope (SSTE): Makes projection and definition more difficult.
- Weak lower lateral cartilages (LLCs): Require reinforcement via SEGs or shield grafts.
- Wide alar base and flaring: Managed through alar base reduction and sill excision techniques.
Repeated structural reinforcement is necessary in these noses to maintain results over time.
Synthetic Materials: Controlled Augmentation
When autologous cartilage is insufficient or limited, we consider the use of synthetic materials like expanded polytetrafluoroethylene (e-PTFE), also known as Gore-Tex®.
Characteristics of e-PTFE:
- Pre-formed and biocompatible with soft tissue adhesion.
- Commonly used for dorsal augmentation, not tip support.
- Must be sculpted carefully to avoid visible contours.
- Prone to infection if sterility is compromised.
e-PTFE implants should be applied with precision and caution, only after other options have been evaluated. Promotion of safe, sterile handling is essential.
Closure and Postoperative Stabilisation
Proper closure and stabilisation techniques complete the surgical process and support the structural changes made.
- Quilt closure of septal mucosa reduces dead space and promotes healing.
- Layered suturing ensures soft tissue stability.
- Dorsal splints and Steri-Strips™ control swelling and help shape the dorsum.
- Sutures and splints are typically removed after 5 to 7 days.
A structured healing protocol supports the integrity of the newly shaped nasal framework.
Adjunctive Procedures for Alar and Nostril Modifications
Structural analysis also informs how we adjust the nasal base and nostrils for better symmetry and proportion.
- Alar lift: Through triangular vestibular skin excision to correct hanging ala.
- Alar base reduction: Using wedge excision to narrow the base and address flare.
- Sequential adjustments: Allow for gradual refinement and contour optimisation.
These minor yet significant procedures support a more balanced appearance and complement the internal structural changes.
The Future of Rhinoplasty: Predictability Through Structure
Structural analysis is not just a surgical technique—it is a mindset. As we move toward more predictable and personalised nasal surgeries, structural analysis allows for:
- Precise surgical planning.
- Long-term aesthetic and functional stability.
- Reduced revision rates.
- Better patient satisfaction.
Moving forward, we aim to refine these principles further, promoting continued innovation in nasal surgery. Every graft, incision, and suture should follow structural logic to ensure results that endure.
