CPS Clinics in Plastic Surgery · 2022

The External Rhinoplasty Approach

Totonchi A, Guyuron B.

What this paper says

A review arguing that although every rhinoplasty should be individualized, a systematic order of steps helps planning and stability, because each adjustment always has a secondary effect beyond its intended one.

Overview

The authors describe the nose as a complex three dimensional structure with structural and functional roles, whose relationship to surrounding features contributes to overall facial harmony. Many variables can be adjusted and many tools exist for adjusting them. The article addresses the external, or open, approach and how to sequence those adjustments.

Sections of note

Review article; the abstract reports no patient numbers, no outcomes, no complication rates and no follow up.
Many dimensions can be altered affecting appearance, structure and function.
Every operation should be individualized to the patient.
A systematic order and algorithm is presented as helpful for operative planning.
Such an order also establishes a logical progression of steps and maintains stability.
Each adjustment has a primary anticipated effect.
Each adjustment will invariably also have a secondary impact.

What it means for a patient

Changing one part of the nose changes others, which is why the sequence of steps matters.
The article recommends a set order while still adapting the plan to the individual.
This is expert guidance. No results, complication rates or comparisons are reported.
The open approach adds an incision across the strip between the nostrils, leaving a small external scar.

Why this paper matters

Rhinoplasty steps interact, so a maneuver that fixes one feature can unbalance another, and unplanned sequencing compounds that. This article argues for a defined order as a countermeasure. Whether a systematic sequence improves results has not been tested.

Terms

External rhinoplasty approach: surgery through an incision across the columella, lifting the nasal skin.
Algorithm: a defined sequence of steps or decisions.
Secondary impact: an unintended knock on effect of a surgical maneuver.
Structural component: a part of the nose providing support rather than shape alone.
Facial harmony: the balance of facial features in proportion to one another.

Summary written by rhinoplasty.cc from the abstract, 2026-09-09; not medical advice. The authors' own abstract follows.

From the abstract

“The nose is a complex three-dimensional structure with critical structural and functional roles; its relationship to surrounding structures is, in part, responsible for a harmonious, pleasing visage as a whole. There are many variables and dimensions that can be adjusted to alter the esthetic appearance, structural…”

Excerpt; the full abstract is on PubMed.