Our beautiful 32 year old patient is seen six months following functional and cosmetic rhinoplasty surgery. You can see a straighter nasal appearance, with nasal profile deprojection. She required spreader grafts on both sides to straighten her nose, and to improve her airway.
Spreader grafts are small pieces of cartilage that may be sewn to your septum and upper lateral cartilages to either fill an indentation, or to improve breathing. In this case, both outcomes were achieved
Our 20 year old beautiful patient is seen 6 months after her functional and cosmetic rhinoplasty surgery. She was bothered by her dorsal hump, and bulbous, droopy nasal tip appearance. There was a restriction in her right internal nasal valve that required a right cartilage spreader graft. In this case, the spreader graft helps to provide a straighter nasal appearance and to help her breathe better through her nose.
When we evaluate our patients who request rhinoplasty, we feel it's important to understand how much someone dislikes their nose. We use a scale from zero to ten. Ten may be defined as the worst possible dissatisfaction, and zero may be defined as no desire for surgery. Our patients who quantify dissatisfaction with their noses at seven or higher are typically eagerly desiring surgery. Rhinoplasty surgery may not be appropriate if someone has only mild to moderate dissatisfaction, or if someone likes their current nasal appearance on occasion. People with a high degree of dissatisfaction for a long duration, with issues we can improve with rhinoplasty, are some of the best candidates for rhinoplasty surgery, since they may be inclined to accept improvement, and experience satisfaction.
These photos of our handsome twenty five year old patient were taken 7 months after rhinoplasty surgery. He had a combined functional and cosmetic nasal procedure since he didn't like the way his nose looked, and he was also having difficulty breathing through his nose. He had previous nasal trauma several times that left him with a crooked nasal appearance, and a deviated nasal septum. Additionally, he had a history of chronic nasal allergy that led to enlargement of his turbinates, so turbinate reduction was performed at the time of his rhinoplasty. His functional and cosmetic rhinoplasty also consisted of septoplasty, tip-plasty, alarplasty (nostril narrowing), hump removal, osteotomies and placement of a right-sided cartilage spreader graft. His spreader graft was carved from his septal cartilage, and was used to provide a straighter nasal appearance, and to open a narrowed internal nasal valve for better breathing.
Turbinates are organs in your nose, about the size of your pinky, that filter and humidify the air you breathe. If you are exposed to things in the air you may be allergic to, it can cause your turbinates to enlarge over time, even if you use nasal saline, nasal steroids, and antihistamines. In our practice, we reduce the turbinates, if necessary, with a bipolar electrosurgical device called a Dennis probe. Turbinate reduction takes under ten minutes to perform, and does not increase pain after rhinoplasty, When turbinate reduction is combined with rhinoplasty, there may be an increased likelihood of a postoperative nose bleed, and temporary nasal crusting is common for up to one month after your procedure. Turbinate reduction, however, may lead to markedly improved nasal breathing when someone has chronic turbinate enlargement from chronic nasal allergy.
You can see a natural looking, and less distracting nasal appearance in our beautiful teenage patient, only four months following rhinoplasty surgery. She was bothered by her dorsal hump and wide nasal tip appearance. After 22 years of performing rhinoplasty, we feel our approach to sculpting the nasal tip leads to natural looking tip appearances.
We prefer an open approach in nearly all of our patients who require tip work, or tip-plasty. This part of her surgery was performed after her septoplasty with harvest of cartilage for later grafting. The nasal tip is transformed into a tripod by dividing the lower lateral cartilages and suturing the medial crura to each other in the midline: With the soft tissue flap still retracted with a pledget, a forcep is placed intra-nasally at the soft tissue triangle which is lifted anteriorly to delineate the angle where the medial crus meets the lateral crus, and a marking pen is used to delineate this position bilaterally. The Brown-Adson forcep is used to retract the vestibular lining into the nose, and the Converse scissor is used to separate the vestibular lining from the undersurface of the lower lateral tip cartilages. In her case, the lower lateral cartilages were divided at their angles, and the medial crura are sutured to each other, approximately 4 mm posterior to the division point, with one 5-0 polydioxanone suture (PDS). The nasal tip is now a tripod where the medial crural complex is the central limb, and both lateral crura are the other two limbs. This maneuver typically results in a change in the spatial relationship between the medial and lateral crura such that the anterior portion of the lateral crura may overlap as the lower lateral cartilages medialize with angle division. This maneuver results in tip narrowing, and her tip is then reinforced with a columellar shoring strut graft (C-Strut).
Her hump was removed with right and left Joseph saws, and the lower 2/3 of her hump was cartilage and was removed with a 15-blade. Lateral osteotomies were performed to "close her open roof", and then her upper lateral cartilages were sutured to her dorsal nasal septum before her surgery was completed.
“Dr. Joseph is amazing and his staff as well! Gloria and Paloma were so sweet and comforting. My first visit there they all made me feel so comfortable and Dr. Joseph listened to what I disliked about my nose and what I hope could be changed. He exceeded my expectations! After my surgery he gave me his personal cellphone number so I could contact him if I had any questions or concerns. From the first visit he’s always been attentive and I appreciate that! I am now 6 months post-op and I could not be happier with my results. 100% recommend Dr. Joseph! You will not be disappointed!”
These photos were taken six months following rhinoplasty surgery. Our beautiful patient was bothered by a broad nasal appearance and a high bridge. You can see a narrower looking appearance with hump reduction for a less distracting appearance. Her residual tip swelling will dissipate over the ensuing six months.
© 2025 Eric M. Joseph, M.D. Telephone: (973) 325-1155
22 Old Short Hills Road, Suite #112 Livingston, NJ 07039