Modifications in the appearance of the nose are performed by altering the underlying skeletal structure of the nose. Depending on the location of the desired physical change, the nasal bones and/or cartilages under the skin may be moved, augmented, or reduced to improve the nasal appearance during the San Francisco rhinoplasty procedure.

Dr. David C. Mabrie uses illustrations to explain how rhinoplasty is performed. He works with men and women from throughout the Bay Area including San Francisco, Oakland and Walnut Creek. Request a consultation online or call us at (415) 445-9513 today.

Skin Incisions in Rhinoplasty

To access the nasal bones and cartilages, incisions are made inside the nose. Sometimes incisions are made through the skin on the structure called the collumella, the thin portion of the nose between the nostrils, in the center of the nose, just above the lips. The incision is carefully made in a zig-zag fashion to help camouflage it when it heals. The scar from this incision may be slightly dark temporarily, but in most cases is eventually imperceptible.

Nose incision placement for rhinoplasty

The blue line shows where the skin incision is typically made. After a few weeks, the incision usually starts to fade. After a few months, the incision is almost inperceptible.

Straightening the Nasal Bone on Frontal View

The type of modification needed depends on the location of the desired change. For deviations or wideness close to the face, the nasal bones must be moved. Controlled precise breaks are created in the nasal bones, which are then repositioned and secured in place usually with a nasal splint worn about one week after surgery.

Reducing Dorsal Convexity (Nasal Hump)

A frequent request of patients is to improve the nasal profile by modifying the bridge (dorsum) of the nose. Many patients of Mediterranean heritage are interested in reducing the hump.

The bridge of the nose is made of both bone and cartilage. To reduce the hump, incisions are made inside the nose. If necessary, pinpoint pricks are made in the skin the help cut the bone. A portion of the bone is then either removed or chiseled. The cartilage is carefully removed, taking care not to over reduce the profile.

Dorsal Augmentation

While San Francisco plastic surgery patients frequently want to reduce the nasal dorsum, there are incidences when there is a need to augment the dorsum. If the dorsum is underdeveloped, the nose may not seem strong enough on profile view.Many African-American and Asian-American patients share an interest in dorsal augmentation, as can be seen in our Balancing Ethnic Features page.

Materials For Augmenting the Profile

There are several materials used to augment a patient’s profile, depending on the amount of augmentation needed and patient and surgeon preference. The patient’s own cartilage or bone, harvested from the nose, ear or skull may be used. Cadaveric cartilage may be used. Several synthetic, medical grade materials are created for this purpose. Dr. Mabrie prefers to use goretex for augmenting the dorsum.

How Dorsal Augmentation Is Done

If the patient only needs augmentation of the dorsum, and no changes in the tip, the procedure may be done in less than an hour with internal incisions. The implant is trimmed to size and fits snugly under the skin. The risk of infection or mobility is extremely low because of the shape and characteristics of the goretex implant. Goretex is extremely well tolerated by the body and used frequently in heart surgery.

Nose during dorsal augmentation surgery

Images from a dorsal augmentation procedure. The implant is modified to fit under the skin and fill in the concave area.

Dr. Mabrie usually performs dorsal augmentation with patients under general anesthesia, although the procedure may be done with only IV sedation. Recovery from dorsal augmentation is rapid, with patients normally feeling comfortable in the public eye within 2-4 days. If there is no work to be done on the nasal tip, all incisions are inside the nose and there is no need for suture removal.

Lifting a Drooping Tip

Many San Francisco nose surgery patients interested in rhinoplasty want to improve their profile view by lifting a drooping nasal tip. When viewed from the side, the ideal angle between the nose and upper lip is about 90 degrees in men (pointing straight ahead.) In women the ideal angle is 110 degrees (pointing slightly upward). A droopy tip may be lifted during rhinoplasty by modifying the nasal cartilages. The cartilage may be sewn together or some of the patient’s own cartilage may be used to refine their appearance from a profile view.

Nostril Flare Reduction

This is an in-office procedure that requires local anesthesia only.The procedure will take about half an hour, and you can expect to be “restaurant ready” in 7 to 10 days.

Non-Surgical Rhinoplasty

Non-surgical dermal fillers such as Restylane®, RADIESSE® and JUVÉDERM® Injectable Gel have become increasingly popular for a non-surgical nose job since they allow you to attain your desired changes in less than one hour, without the post procedure down-time necessary from a surgical procedure.

Rhinoplasty with Chin Augmentation

Many patients who request rhinoplasty surgery in San Francisco would also benefit from chin augmentation surgery. Both the nose and chin have a large affect on the appearance of your facial profile. In addition to the sizes of the nose and chin, the relative proportions of the structures to each other is very important. If the chin is proportionately underdeveloped in relation to the rest of the face, it can make a slightly large nose look even bigger. Dr. Mabrie frequently performs chin augmentation and rhinoplasty together. Chin augmentation is a relatively straight-forward procedure and only adds about an hour to the length of the case.

Dr. David Mabrie

For more than a decade, Dr. David Mabrie has been perfecting his technique for optimizing facial beauty with dermal fillers. He is the only facial plastic surgeon in San Francisco whose practice is focused entirely on injectables.