Answer:
The nose is divided into three parts, the bony dorsum, the cartilaginous dorsum and the tip.  When a nose is crooked each portion needs to be made straight individually and as a unified nose.  The bony dorsum is straightened by performing osteotomies, cuts in the bones and moving them to the midline.  The cartilaginous dorsum is made up of the nasal septum and the upper lateral cartilage.  If the septum is inherently deviated it can be excised and reconstructed.  If the upper lateral cartilage is deviated or asymmetric then it can be straightened by adding grafts either between the septum and upper lateral, called spreader grafts or by grafting cartilage on top, called an onlay graft.  The tip cartilage again is often affected by the nasal septum and creating a straight septum is the first step.  The cartilage itself is then sutured into position to create a straight symmetric nasal tip. 

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Answer:
There are many different changes that can be made during rhinoplasty.  They can be summarized into making the nose smaller, making it bigger or correcting asymmetries or deviations.  Most commonly patients are trying to make their noses smaller or more symmetric.  In many cases though, the actual procedure involves making some portions smaller and others larger in order to create a balanced natural appearing nose.

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Answer:
Rhinoplasty can certainly improve a small turned up nose. Usually individuals with that sort of nose also have thin skin and fine cartilages. Facial features are also usually delicate. Therefore, the rhinoplasty goals are to decrease the degree that the nose turns up and perhaps add a small degree of width to the nose. This is certainly reasonable and the improvement expected should be significant.

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Answer:
A book could be written on this question.  Not only are there cartilage grafts that can be placed on the nose, onlay grafts, but there are all kinds of grafts that can be placed in the tip, spreader grafts, rim grafts, lateral crural grafts, etc.  Additionally, some artificial materials can be used in rhinoplasty as well, although we limit the use of these to the most rare case as we prefer cartilage whenever possible. 

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Answer:
We utilize an open rhinoplasty approach for fixing under-projection.  In most cases we add a cartilage graft to the end of the septum and then lift the tip cartilages and secure them to this graft in a more projected position.  In cases of a pre-existing long septum this can be done without the graft.  In more severe cases, we may place a graft of cartilage directly on the nasal tip, called a tip graft.  Smaller degrees of projection may be obtained with dome cartilage suture techniques.

Posted by Dr. Buckingham