A systematic, graduated approach to rhinoplasty

Rhinoplasty may be viewed as one of the most technically demanding procedures in facial plastic surgery and requires a level of sophistication derived from diligent study, repetitive execution, and critical review. During the preoperative evaluation, the physician must exercise a systematic approach that includes a thorough investigation into the psychological and physical aspects of the individual patient. A systematic, graduated approach should be undertaken in every rhinoplasty in which the three cornerstones-planning, simplicity, and flexibility-are recalled. Planning entails a thoughtful and critical analysis of what surgical techniques may be best enlisted to achieve the envisioned aesthetic effect. Simplicity argues in favor of performing only those surgical procedures needed to accomplish the task at hand to minimize the variables that arise from protracted, ill-defined surgery. Flexibility implies that the surgeon be capable of modifying his plan if unforeseen operative events disrupt the proposed course of action. All three principles reflect the authors' philosophy about the surgical approach to rhinoplasty, that is, the discretionary use of endonasal (nondelivery and delivery) and external incisions as warranted by circumstance.