Surgical Adjuncts to Rhinoplasty: An Algorithmic Approach

Overview

How a nose looks depends on the bone and soft tissue around it, including the upper jaw, forehead, chin and lips. This review searched the literature for procedures on those surrounding features that are used to supplement rhinoplasty, and organized them by when each is indicated.

Sections of note

• Structures identified as affecting nasal appearance: the maxilla, septum, frontal bone, mandible, and the soft tissues and cartilage surrounding the nose.
• Literature search used PubMed, Google Scholar and a university library database to find papers on adjunctive procedures.
• Indications and preoperative analysis were extracted from each paper, with supplementary literature sought where an indication was unclear.
• 16 papers in total described adjunctive procedures.
• Each described a procedure or set of procedures on a surrounding facial feature: forehead, brow, cheeks, lips, chin and neck.
• 13 adjunct procedures are described with their respective indications.
• The stated conclusion is that recognizing these relationships helps identify when an adjunct is indicated, improving aesthetic balance. Level of evidence II.

What it means for a patient

• The nose is judged against the chin, cheeks and lips, so changing one of those can change how the nose reads.
• Thirteen additional procedures exist that surgeons may propose alongside rhinoplasty.
• The algorithm links each to a specific preoperative finding rather than offering them generally.
• Limits: only 16 source papers were found, and the review reports indications rather than outcomes.

Why this paper matters

Facial balance rather than the nose alone determines whether a result looks right, and adjunct procedures are often discussed unsystematically. Tying each to a defined indication makes the offer checkable. No outcome data supports the algorithm.

Terms

• Adjunct procedure: An additional operation performed alongside the main one.
• Maxilla: The upper jaw bone, which forms the floor of the nose.
• Mandible: The lower jaw bone.
• Aesthetic balance: How well facial features are judged to fit together in proportion.
• Algorithmic approach: Decision-making structured as a sequence of defined rules.