Nasal Bone Osteotomy with Narrowing, Tip Plasty, Alar Rim Lowering (Skin Graft, Auricular Cartilage Graft)

Treatment details: Nasal Bone Osteotomy with Narrowing, Tip Plasty, Alar Rim Lowering (Skin Graft, Auricular Cartilage Graft)

This was a structural rhinoplasty rather than an augmentation. Narrowing osteotomies addressed the bony width, the tip was reshaped, and the alar rims were lowered using both a skin graft and cartilage harvested from the ear, which is what allows the nostril margin to be repositioned and held there. Using the patient’s own ear cartilage avoids introducing a foreign material into a region that has to move naturally. Six months out, the bones are stable, the grafts have taken, and most of the swelling that obscures tip definition has resolved. Fine changes continue for up to a year, and the scars pale over a similar period.

Cutting and narrowing the nasal bones produces swelling of the middle face and dark bruising of both lower lids for about two weeks, and a splint protects the nose at first. Nasal blockage, crusting and watery eyes are usual early, and vision can be blurred briefly while the lids are swollen. Bleeding and infection are uncommon. The bones may heal with a small step, ridge or slight asymmetry, and revision is sometimes chosen after the swelling has fully gone.

Work on the tip cartilages keeps that part of the nose swollen and stiff longer than the rest, commonly six months to a year before the outline is final. The tip is numb or oversensitive for months. Sutures and cartilage can become palpable or visible as the skin thins over them, the tip may rotate or drop with healing, and small differences between the nostrils are common. Additional correction is needed in a proportion of cases.

A graft depends on new vascular ingrowth to survive, so part or all of it can fail, leaving a patch of different color or texture at the nostril rim. The donor site on the ear leaves a scar and a small change in ear shape, and cartilage may warp or be felt as an edge over time. Swelling at the rim lasts months, the two nostrils can differ, and revision is possible. Infection and bleeding are uncommon.