For augmentation rhinoplasty, autologous tissues including bone, cartilage, soft tissue and implant (silicon, goretex) are available. For tip plasty, autogenous conchal cartilage and septal cartilage can be used. Donor site morbidity is minimal in functional and cosmetic aspects.

Augmentation rhinoplasty can be classified into closed and open rhinoplasty. For the refined tip plasty and fine handling with cartilage framework, open rhinoplasty including infracartilaginous and columellar incision is preferred.

To achieve attractive nasal look, the shape of tip as well as columella is important. Slightly elevated tip is aesthetically acceptable. Bulbous tip and low profile nose shoud be corrected with augmentation and rip plasty.

Moderate to high profile nose with bulbous tip can be helped with the tip plasty only. L-shape implant was used for the simultaneous one-stage augmentation of nasal dorsum and tip. However, recently this is almost abandoned owing to the complications including the skin irritation. Recently, autogenous cartilage or allocartilage are widely used and several suture technique on the alar, upper, and lower lateral cartilage is available.

Upper 1/3 of the nose is composed of one pair of nasal bone. Lower 2/3 of the nose comprises two pairs of cartilage. Hump on the junction between the bone and cartilage may be removed and smoothed for the better nasal profile. In case of broad nasal dorsum, narrowing and humpectomy including bony portion should be considered first, then 2ndary augmentation rhinoplasty is necessary. If the hump is small, surgery can be operated under local anesthesia. However, if the narrowing of the nasal dorsum is indicated or other procedures are necessary, general anesthesia is inevitable.

Alar flaring makes one look crude. Alar width should be similar with the intercanthal distance in the asthetic nose. Alar resection can narrow the alar base and correct the alar flaring. Augmentation rhinoplasty and tip plasty can be performed at the same time with this procedure. Inconspicuous scar is made just above the facial-alar groove.

Patients are not aware of their deviated nose right after the trauma owing to the swelling. If the patients were hurt on their nose when they were extremely young, they don’t tend to recognize their deformity. Incomplete or imprecise closed reduction of the nasal bone fracture is another frequent cause for the delay of the treatment. For the corrective rhinoplasty, osteotomy is often needed via piriform aperture or percutaneously. In case of percutaneous osteotomy, 3 to 4 mm of tiny incisions are necessary, however scar is inconspicuous.

General anesthesia is inevitable because osteotomy and manual infracture of the nasal bone are often necessary. 1 to 2 days of hospitalization period is required. If concomitant septoplasty is planned, curved septal cartilage is resected and used for the tip plasty or augmentation of the dorsum. Sometimes, silicon or goretex implant can be inserted for the better profile. However, rib bone and/or cartilage should be utilized for the correction of severely deviated S-shape nose resulting from the repeated fractures or depressed nose. In addition, corrective rhinoplasty is of benefit to the large nostril sill, retracted or hanging columella, and narrow nasolabial angle.