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Rhinoplasty Nose Surgery Article 4

Operative Details in Rhinoplasty and Follow-up

The Nasal Tip

The nasal tip can be altered by dozens of maneuvers. Only the most common maneuvers will be discussed here.

Columellar Strut

Sometimes, a columellar strut can be placed to elevate the tip. Usually, the graft is taken from the septum at the time of the rhinoplasty. Sometimes, the cartilage taken from the dorsal hump removal can be used as a strut or as cartilage graft needed elsewhere.

Tip Sutures

Tip sutures or stitches are used in their various forms to mold the tip to be more narrow or create lift or improve asymmetry. These stitches are placed into the cartilaginous structure itself. These are very powerful stitches in altering a nasal tip in rhinoplasty. Interdomal and intradomal sutures reduce nasal width and produce tip definition by creating the ideal cartilaginous framework for the tip.

Cartilage Grafts

Cartilage grafts can be harvested from septum, ear, or rib in general. They are used for a multitude of purposes. Cartilage grafts can be crushed to improve symmetry in crooked nose cases. Rib cartilage can be used to recreate a dorsum in traumatic deformities. Cartilage grafts can be used for tip projection or definition.

Sometimes grafts can be used to hide tip asymmetry. When possible, excised alar cartilage can be used as grafts to provide subtle tip refinement and accentuate changes produced by suturing. When this cartilage does not suffice or more is needed, cartilage can be harvested from the septum or the ear.

The internal incisions are closed with light sutures. No nasal packing or internal splints are placed, so breathing is not compromised. A small white nasal splint will be placed. This concludes the surgery.


Dr. Hughes will see you in one week to remove the splint. Patients frequently notice improvement in appearance immediately with marked improvement at three weeks. Many of Dr. Hughes’s postoperative photos in the rhinoplasty photo gallery are taken at the three week follow-up appointment. However, full improvement may take one year.