Closed Rhinoplasty

Modern rhinoplasty has moved away from simply reducing bone. In Prof. Tezel's tip-oriented approach the nasal tip is the anchor of the whole operation. When the tip is given the right projection and rotation, the hump appears smaller on its own, so the bridge needs much less reduction, and conservative surgery looks more natural.

• ·A tip that does not droop when you smile
• ·Better support for the nasal valves and easier breathing
• ·Natural connections between skin and cartilage left intact

The tip cartilages are shaped entirely from inside the nose and fixed to the septum, the central carrier cartilage, with the septocolumellar suture. Prof. Tezel published the method in the Annals of Plastic Surgery in 2007. It works as a sequence of sutures, each with a specific job:

1. 01Pivot suture: sets the height of the tip to the millimetre.
2. 02Rotation suture: fixes the upward angle of the tip.
3. 03Support suture: controls the angle between the nose and the upper lip.
4. 04Interdomal suture: brings the tip cartilages together for a refined, defined tip.

Because the tip is locked to a stable column, it does not fall over time and is not pulled down by the upper-lip muscles when you smile. Where the septum is too short, weak or crooked to hold the suture, it is first reinforced with a caudal septal graft of your own cartilage.

With the tip correctly positioned, many patients do not need their nasal bones broken at all. In suitable cases the ideal result can be achieved by working on the tip alone. Less bone work means less bruising, less swelling and a noticeably shorter recovery.

Even a well-made nose can look operated if it merges with the forehead in a single straight line. The depth of the area between the brows, the nasal root, is decisive for a natural profile, and it is especially visible in photographs.

Conventional instruments made this angle hard to create. Prof. Tezel designed an angled rasp for the purpose, published in the Journal of Plastic, Reconstructive & Aesthetic Surgery in 2009, so the transition between forehead and nose can be shaped precisely.

1. 01Day 7: splint removed; you are usually ready to fly.
2. 02Weeks 2–3: a temporary stiffness of the upper lip is normal and fades.
3. 03Weeks 6–8: the cartilages fuse into a permanent 'biological cast'. Do not massage the tip and avoid knocks.
4. 04Around 12 months: the final shape is fully refined.