Rhinoplasty or nose reshaping is one of the most common plastic surgeries made today. Often, the structure or size of the nose is not proportionate with other facial features. Nose reshaping corrects the disproportionate appearance by changing the size or shape of nose, nostrils and opening the angle between the nose and upper lip  In addition,  it can correct a nasal birth defect or chronic respiratory problems. It is important to know the minimum age for rhinoplasty is 16 years since the procedure must be performed after the nose has finished developing.

Nose structure is composed mainly of bone and cartilage.  Upper part of the nose is made of bone. Lower part of the nose is formed of cartilage which determine the shape and appearance of the nose tip Dorsal part (hump) is an assembly of bones and cartilage.

In open rhinoplasty,  the surgeon is making small incisions inside of every nostrils, making it together at the level of columella the least restricted access to the cartilage and bone of the nose but  is also more likely to cause scarring. These incisions allow the doctor to lift the skin from bone and nasal cartilage  By this method it can be clearly examined the structure of the nose and can be made accurate adjustments on the form and structure, especially on the tip of the nose.

In  close rhynoplasty , the physician makes small incisions inside of both nostrils, without getting it together at the level of columella, and the intervention does not require the skin over the nose to be lift it. This kind of intervention limits the access to the tip of the nose and possible adjustments! Therefore, to those with closed rhinoplasty , the tip remains too long or slightly curved downward, because is not addressed properly! 

Using very small instruments, the doctor will reshape the nose by removing or adding bone, cartilage and tissue to achieve the desired effect. 

Laser surgery, which has  combustion effect, it is not used, in general, because by burning nasal cartilage, may lead to necrosis resulting unaesthetic effects. Sounds great and there are patients who would pay more for this  illusion!

An open rhynoplasty surgery may last between 2 -3 hours. The surgery is performed under general anesthesia.  There are still surgeons who perform under local anesthesia, but: it is painful at one time, the patient becomes agitated, and this increases the bleeding, at which decreases visibility leading to bad effects. It's better for you to sleep and not feel anything.  And the surgeon is performing more relaxed and faster.

 Open Rhynoplasty it is recommended ( G: Aiach): when the tip of the nose needs reshaping (wide, bulbous, fell, too long, too "thrown" in front, etc..),, in  case of lateral deviation, in case of large noses or in secondary corrective rhynoplasty, meaning over  80% from total cases. The close rhynoplasty is limited to few cases with slight dorsal deflection.

Another aspect is whether to perform or not septoplasty? In accordance with some authors(Golden and Meyer), in over 75% from the cases of patients with septoplasty, the surgery should be done! Nose shape and direction is given mainly by the septum  ("Where the Septum goes, the nose goes!), the case when septoplasty should be done.  10 minutes more are needed!
Incisions inside the nose will be closed with dissolvable sutures. Pads are applied in the nostrils (for 24-48 hours), and a metal splint on the outside (7 days) to provide support and stabilize the nose as it heals. 

 The pain is minimal and passes with usual painkillers, but a sensation of  clogged sinuses  (like a cold) are normal in 2-3 days.  You will have bruising and swelling, especially in the upper area of the face and around eyes . These symptoms will begin to disappear in the next few days after surgery.   The bruises will disappear and you can return to work after 7-10 days from the surgery. The result visible immediately, but the nose is placed up  1 year after surgery! 
Although nose reshaping surgeries are not designed to obtain perfection, only to adjust the proportion and profile of the nose, rhinoplasty can help significantly improve your confidence and appearance.

Types of rhynoplasty:

Classics

Are the most common .Generally, it's a dorsal deformity (hump), a tip bit too long and thick, a nose which is too in front, and the angle between nose and upper lip is below 90 degrees.
Require reducing the humpback, especially to reduce previously projected tip, to lift and define the tip of the nose - which is best performed by open rhynoplasty.

                                                                                                                                                                                                                                                                                                                                                                                                                                                                  

Addition

In these cases  the procedure consists in adding bones , etc!
Although  in over 95% from the cases rhynoplasty is performed when dealing with a too large nose, there are a few cases when is needed to add something and not to remove(rhinoplasty additive), for  a natural result. In this case, is needed to be harvested cartilage from the septum, ear or from the iliac rib or an shapeable silicone implant. Procedure involves forming a pocket in which are applied either of implants with or without discrete reshape of cartilage and nasal bones, followed by fixing it in position by a bandage and / or wires.

                                           

Laterally diverted
Cases when the nose deviates from midfield of the face  in a conspicuously asymmetrical way .
Can coexist with other deformities: the hump, tip or septum. 
In this case, it requires open rhynoplasty and septoplasty ,unequivocal.

                                                                                                                                              

Minors

Needs to be performed very carefully!
 When dealing with a large nose and visibly deformed, after any type of procedure it will look better, even if it is  defective.
In cases of noses with slight defects, however, the surgery must be done very  carefully and meticulously as any imperfection will be easily noticed!  These cases can be more demanding then classical one, paying attention to the detail .

                                                                                                                                                                    

Secondary

Interventions may be the hardest, because after a previous intervention  the nose structure is changed. Dissection is more difficult, and often need to be added a cartilage from the septum or ear in order to strengthen the resistance of the nose structures.Open rhynoplasty is the most common but not the only option.