Rhinoplasty Procedures
All cosmetic surgery involves risks and individual results vary. Cosmetic surgery is a serious decision. Decisions about whether to proceed should be made after careful consideration and following at least two consultations with a qualified medical practitioner.
Rhinoplasty is not a single operation — it is a family of procedures that can be combined and adapted in many different ways depending on what the patient needs, what their anatomy allows, and what goals the surgeon and patient have agreed on together. This page gives an overview of the principal categories of rhinoplasty procedure, the techniques within each, and how different elements are combined in a single operation. For detailed information on any specific technique, the linked pages provide a more thorough discussion.
Cosmetic surgery is a serious decision. Read the full rhinoplasty risks page →
Functional Rhinoplasty
Functional rhinoplasty refers to surgery aimed primarily at improving nasal breathing rather than changing the external appearance of the nose. Functional procedures may be eligible for Medicare rebates and private health insurance contributions where clinical criteria are met. The specific criteria, relevant item numbers, and expected out-of-pocket costs are discussed at consultation.
Septoplasty
The nasal septum — the central dividing structure of the nose — is rarely perfectly straight. A deviated septum can significantly restrict airflow through one or both sides of the nose. Septoplasty involves surgical straightening of the deviated septum through internal incisions, without external scars. The outer L-strut of the septum (the dorsal and caudal edges) must be preserved to maintain the structural support of the nose. The inner portion of the septum, once straightened, is often harvested as cartilage graft material for use in the same or future procedures.
Turbinoplasty (Inferior Turbinate Reduction)
The inferior turbinates are paired bony and mucosal structures that project from the lateral walls of the nasal cavity, warming and filtering inspired air. Persistently enlarged turbinates — from allergy, chronic mucosal swelling, or compensatory hypertrophy in response to a deviated septum — can contribute significantly to nasal obstruction. Turbinoplasty reduces the volume of the turbinates through a variety of techniques (submucosal reduction, outfracture, or radiofrequency ablation) to improve the nasal airway without compromising their filtering and humidifying function.
Nasal Valve Surgery
The internal and external nasal valves are the two narrowest points of the nasal airway and frequent sites of functionally significant obstruction. Internal valve narrowing — where the angle between the upper lateral cartilage and the dorsal septum is too acute — can be addressed with spreader grafts or spreader flaps, which widen the valve and support the middle vault. External valve collapse — where the lateral crura of the lower lateral cartilage are weak or malpositioned, allowing the nostril rims to collapse inward on inspiration — is addressed with alar batten grafts or lateral crural strut grafts, which restore stiffness to the lateral nasal wall.
Cosmetic Rhinoplasty
Cosmetic rhinoplasty aims to change the external appearance of the nose — its size, shape, proportions, or specific features. It is performed under general anaesthesia and is not eligible for Medicare rebates where the indication is purely cosmetic. A comprehensive assessment of the nasal airway is always conducted before any cosmetic rhinoplasty, because cosmetic changes to the nose can affect breathing function if not carefully planned.
Dorsal Hump Reduction
A prominent dorsal hump — the bump visible on the nasal bridge in profile — is one of the most common cosmetic concerns addressed in rhinoplasty. The hump is composed of bone in its upper portion and a mix of bone and cartilage at the keystone area. Conventional hump reduction involves excising the excess tissue, which creates an open roof that must then be closed with lateral osteotomies. Preservation rhinoplasty offers an alternative approach in selected patients — lowering the dorsum while maintaining its continuity, potentially preserving the dorsal aesthetic lines and avoiding the open roof deformity. More detail →
Tip Rhinoplasty
The nasal tip is the most technically complex region to modify. Tip work may involve narrowing a wide tip, increasing or decreasing tip projection, rotating the tip upward (cephalic rotation) or downward, correcting tip asymmetry, or redefining the tip-defining points. Modern tip rhinoplasty relies on a combination of suture techniques — interdomal, transdomal, and columellar sutures — and cartilage grafting, principally the columellar strut graft for tip support and cap or shield grafts for definition.
Nasal Bridge Narrowing
A wide nasal bridge — where the nasal bones are splayed apart, creating an excessively broad upper third — is narrowed through lateral osteotomies: controlled fractures of the nasal bones that allow them to be repositioned closer to the midline. Medial osteotomies may also be used. Osteotomies are always performed as part of a planned series of manoeuvres and the degree of narrowing achievable depends on the starting width of the nasal bones and the elasticity of the overlying skin. More detail →
Alar Base Reduction
Where the alar base — the outer width of the nostrils — is disproportionately wide in relation to the rest of the nose, alar base reduction removes a carefully designed wedge of tissue from the alar-facial groove to narrow the nostril width. This leaves a small scar in the natural shadow of the nasal base that typically heals to a fine, barely visible line. Alar base reduction is often performed in combination with other rhinoplasty manoeuvres. More detail →
Non-European Rhinoplasty
Rhinoplasty goals and techniques vary significantly across different ethnic backgrounds. Asian rhinoplasty, for example, often involves adding projection and definition rather than reducing size — augmenting a low dorsum, refining a wide and poorly defined tip, and narrowing the alar base. Middle Eastern rhinoplasty may address a prominent dorsal hump while maintaining ethnic facial harmony. The appropriate goals and techniques for each patient depend entirely on their individual anatomy and their own clearly expressed objectives — not on any assumed aesthetic standard. More detail →
Combined Functional and Cosmetic Rhinoplasty (Septorhinoplasty)
Many patients present with both functional and cosmetic concerns, and these can often be addressed simultaneously in a single procedure. A combined septorhinoplasty addresses a deviated septum (and the breathing problems it causes) alongside external cosmetic changes to the nose, avoiding the need for a second anaesthetic and allowing the airway and appearance to be optimised together.
Where functional components of the combined procedure meet the clinical criteria for Medicare and private health insurance eligibility, a partial rebate may be applicable to the eligible components. A detailed cost breakdown for combined procedures is provided at consultation.
It is clinically important that the airway implications of every cosmetic manoeuvre are considered: narrowing the nasal bridge with osteotomies can compromise the internal nasal valve if spreader grafts are not used; over-resection of the tip cartilages can cause external valve collapse; rotation of the tip can affect the nasolabial angle and indirectly change the character of the airway. A thorough Specialist Otolaryngologist assessment of the functional implications of each planned cosmetic change is a core component of safe rhinoplasty planning.
Surgical Approach — Open, Closed, or Preservation
Regardless of whether the procedure is functional, cosmetic, or combined, rhinoplasty can be performed through one of three main approaches:
A small incision across the columella allows the skin to be elevated and the full nasal framework visualised under direct vision. Preferred for complex tip work, significant grafting, revision cases, and asymmetry correction.
All incisions inside the nostrils — no external scars. Faster recovery and less swelling. Appropriate for selected cases where the degree of change does not require full open access.
Reshapes the nose while keeping as much of the original anatomy intact as possible. Used in selected primary cases where anatomy permits. Avoids extensive deconstruction and rebuilding of the nasal framework.
The approach used is selected based on the individual patient’s anatomy and the goals of surgery. The choice is discussed and explained at consultation, and may involve elements of more than one approach.
Rhinoplasty Surgery Overview → | Rhinoplasty for Men → | Ethnic Rhinoplasty → | Septorhinoplasty → | Rhinoplasty Risks → | Planning a Rhinoplasty → | Arrange a Consultation →
Dr Roth’s Clinical Perspective
The range of rhinoplasty procedures reflects the fact that the nose is not one problem but many — a dorsal hump is a different technical challenge from a bulbous tip, which is different again from a deviated nose or a post-traumatic deformity. The surgeon needs to be genuinely comfortable with all of these presentations and to select the approach and technique based on the anatomy in front of them. A surgeon who uses the same technique for every rhinoplasty is not adapting to the anatomy — they are adapting the anatomy to their technique, which is not the same thing and produces less consistent results.
— Dr Jason Roth, MBBS, FRACS (ORL-HNS), IBCFPRS
Specialist Otolaryngologist & Head and Neck Surgeon
Specialist registration — Otorhinolaryngology, Head & Neck Surgery
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