Etiologically, the open and closed approaches to rhinoplasty correction resolve:
(i) nasal pathologies (diseases intrinsic and extrinsic to the nose);
(ii) an unsatisfactory aesthetic appearance (disproportion);
(iii) a failed primary rhinoplasty;
(iv) an obstructed airway; and
(v) congenital nasal defects and deformities.
(vi) Congenital abnormalities such as:
(a) Cleft lip and palate in combination; cleft lip (cheiloschisis) and cleft palate (palatoschisis), individually.
(b) Congenital nasal abnormalities
(c ) Genetically derived ethnic-nose abnormalities
(vii) Acquired abnormalities such as:
- Allergic and vasomotor rhinitis — inflammations of the mucous membrane of the nose caused by an allergen, and caused by circulatory and nervous system disorders.
- Autoimmune system diseases
- Bites — animal and human
- Burns — caused by chemicals, electricity, friction, heat, light, and radiation.
- Connective-tissue diseases
- Inflammatory conditions
- Nasal fractures
- Naso-orbito-ethmoidal fractures — damages to the nose and the eye-sockets; and damage to the bones and the walls of the nasal cavity; it is the ethmoid bone that separates the brain from the nose.
- Neoplasms — malignant and benign tumors
- Septal hematoma — a mass of (usually) clotted blood in the septum
- Toxins — chemical damages caused by inspired substances — e.g. powdered cocaine, aerosol antihistamine medications, et cetera.
- Traumatic deformities caused by blunt trauma, penetrating trauma, and blast trauma.
- Venereal infection — e.g. syphilis
A rhinoplasty correction can be performed on a patient who is under sedation, under general anaesthesia, or under local anaesthesia; initially, a local anaesthetic mixture of lidocaine and epinephrine is injected to numb the area, and temporarily reduce vascularity, thereby limiting any bleeding.
Normally, the plastic surgeon first separates the nasal skin and the soft tissues from the osseo-cartilagenous nasal framework, and then corrects (reshapes) them as required, afterwards, sutures the incisions, and then applies either an external or an internal stent, and tape, to immobilize the newly reconstructed nose, and so facilitate the healing of the surgical cuts.
Sometimes, the surgeon uses either an autologous cartilage graft or a bone graft, or both, in order to strengthen or to alter the nasal contour(s). The autologous grafts usually are harvested from the nasal septum, but, if it has insufficient cartilage (as can occur in a revision rhinoplasty), then either a costal cartilage graft (from the rib cage) or an auricular cartilage graft (concha from the ear) is harvested from the patient’s body.
When the rhinoplasty requires a bone graft, it is harvested from either the cranium, the hips, or the rib cage; moreover, when neither type of autologous graft is available, a synthetic graft (nasal implant) is used to augment the nasal bridge.