Types of Rhinoplasty

👃 Types of Rhinoplasty

Rhinoplasty is classified on the basis of four criteria.

In this post, we will discuss:

• Classification based on purpose
• Classification based on surgical approach
• Classification based on timing / previous surgery
• Classification based on extent of correction

📋 Classification of Rhinoplasty

1️⃣ Based on Purpose

A. Cosmetic (Aesthetic) Rhinoplasty

👉 Primary indication: Cosmetic improvement of the appearance of the external nose

The patient's own desire and motivation for cosmetic improvement is the main indication.

⭐ A thorough pre-operative assessment, psychological evaluation and photographic documentation are essential.

⚠️ Assess whether the patient's expectations are realistic, or whether a minor deformity is magnified in their own perception.

What are the common Indications of Cosmetic Rhinoplasty?

What are the common procedures done in Cosmetic Rhinoplasty?

What is the pre-operative assessment for rhinoplasty?

B. Functional Rhinoplasty

👉 Purpose: Correction of a functional problem, mainly nasal obstruction

An external nasal deformity causing nasal obstruction becomes a functional, not a cosmetic problem.

What are the common Indications of Functional Rhinoplasty?

What are the common procedures done in Functional Rhinoplasty?

C. Reconstructive Rhinoplasty

👉 Purpose: To restore the nasal form, structure and function after tissue loss or deformity

What are the common Indications of Reconstructive Rhinoplasty?

⭐ Three Layers Rebuilt in Reconstructive Rhinoplasty

1- Mucosal lining

2- Osteocartilaginous framework

3- Skin cover

Grafts Required

• Cartilage graft
• Bone graft
• Regional flaps

2️⃣ Based on Surgical Approach

⭐ This is the most commonly followed classification.

A. Closed (Endonasal) Rhinoplasty

All incisions are placed entirely within the nostrils, with no external incision and no external scar.

Indications

⭐ Indications are limited.

• Minor hump reduction
• Simple cosmetic correction

What are the advantages and disadvantages of Closed Rhinoplasty?

B. Open (External) Rhinoplasty

An external incision is given, which is quite small and does not leave a large scar.

Incisions Used

• Transcolumellar incision, connected to
• Bilateral marginal incisions

👉 This gives wide exposure of the nasal tip cartilage and the entire nasal framework.

What are the incisions used in rhinoplasty?

Indications

• Revision cases, where scarring and fibrosis are expected
• Severe deformity
• Complex tip deformity
• Complex reconstruction requiring extensive grafting

What are the advantages and disadvantages of Open Rhinoplasty?

What are the differences between Open Rhinoplasty VS Closed Rhinoplasty?

3️⃣ Based on Timing / Previous Surgery

A. Primary Rhinoplasty

The first rhinoplasty performed on the patient.

B. Secondary (Revision) Rhinoplasty

Performed in a patient who has already undergone a previous rhinoplasty, to correct residual deformity or functional problems.

⭐ Technically one of the most difficult rhinoplasty procedures.

What are the common causes for Revision Rhinoplasty?

What are the difficulties encountered in Revision Rhinoplasty?

4️⃣ Based on Extent of Correction

A. Reduction Rhinoplasty

👉 Aimed at reducing the size of an overly large or humped nose

⭐ The most commonly performed type of corrective rhinoplasty.

Examples

• Hump reduction
• Narrowing a broad nose
• Tip refinement

B. Augmentation Rhinoplasty

👉 Aimed at increasing the projection or size of the nose, using grafts or implants

Examples

• Saddle nose deformity
• Post-traumatic collapse
• Congenitally flat nose

What are the donor sites for grafts used in Augmentation Rhinoplasty?

⭐ Exam Pearls

• Rhinoplasty is classified on the basis of purpose, surgical approach, timing and extent of correction
• Functional rhinoplasty corrects nasal obstruction
• Reconstructive rhinoplasty rebuilds three layers: mucosal lining, osteocartilaginous framework and skin cover
• Classification by surgical approach is the most commonly followed
• Closed rhinoplasty → No external scar, but limited exposure
• Open rhinoplasty → Transcolumellar incision with bilateral marginal incisions
• Open approach is preferred for revision and complex cases
• Secondary (revision) rhinoplasty is technically the most difficult
• Reduction rhinoplasty is the most commonly performed corrective rhinoplasty

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