• Nasal Septum: Septum (the cartilage in the nose that separates the nostrils) is the key supporting structure of the lower two thirds of the nose. The nasal septum is involved in almost every rhinoplasty operation.  Deviated noses have an underlying twisted septum which may also cause nasal blockage. The anatomy of the septum and its peripheral attachments are key in performing rhinoplasty.

  • Previous nasal surgery or trauma: The presence of scarring, absence of cartilage tissue for grafting purposes and in some cases poor blood supply make any revision surgery much more difficult with greater risk of complications. Such surgeries often require additional graft material such as those harvested from the ear or rib cartilage.


  • Texture and thickness of the skin: Thin skin makes it is easier to achieve fine refinement, but it also makes irregularities more visible. On the other hand, thick skin is great in covering up minor irregularities but since it does not shrink well, it will not show fine underlying refinements.

  • Age: Age is a consideration, it is not advisable for teenagers to undergo rhinoplasty before they have completed their growth spurt at about the age of 16 for girls and 17 for boys. Younger patients with a smooth complexion are better candidate for surgery since their skin has more elasticity and can mould onto underlying structures.

  • Ethnic nose: It is important to respect patients’ wishes to alter or enhance the nasal feature while staying true to their ethnic origin or cultural group.

  • Facial harmony: The challenge is not just to improve the nose’s cosmetic appearance but also to ensure that it is in harmony with the patients’ unique facial structure. Balance among different aesthetic units of the face also plays a very important role in creating facial harmony. Horizontal and vertical anatomical ratios can provide a useful framework for cosmetic interventions and what can be considered as aesthetically pleasing. Of course there is ethnic and gender variations.

  • Nasolabial angle: The ideal nasolabial angle for men is about 90 - 95 degrees and for women is about 95 - 105 degrees .

  • Facial features: It is not realistic to get a perfect result in presence of another facial asymmetry. A small chin can give an impression of a large nose. In these photos, you can see correction of the chin size (genioplasty or chin implant) makes the same nose look less prominent and more proportionate to the rest of the face.


Deviated septum diagram
Nasolabial angle
Facial subunits.jpg