Why is rhinoplasty so difficult? The answer is the wide variation in the patient’s nasal anatomy and aesthetic desires. For the surgeon, the challenge is mastering the endless number of operative techniques available. Thus, the question becomes can one devise a basic rhinoplasty operation? A former resident who was 3 years into private practice made the following request: “Can you give me a basic rhinoplasty operation with which I can get good results and have few revisions?” My answer was quick and blunt – “It is impossible because both the anatomy and the requisite techniques are too varied.” Despite my negativity, the desire to develop a basic rhinoplasty operation has continued to intrigue me. Gradually, the fundamentals of a standard rhinoplasty operation began to crystallize. The following operation is intended for the average well-trained plastic surgeon. It can be expanded to fi t a large range of nasal deformities. However, it requires that the surgeon accepts two principles. First, the surgeon must begin by doing only those cases which fi t within their surgical comfort zone. Second, the surgeon must implement a progressive approach for learning rhinoplasty surgery. One begins with easier Level 1 cases and then advances to the more challenging Level 2 deformities before ultimately taking on the most diffi cult Level 3 problems. Distribution wise, perhaps 70% of the primary cases are Level 1, 25% are Level 2, and only 5% are Level
3. A fundamental operation will be presented in a step-by-step fashion in this chapter and its progressive adaptations for the three levels of deformities will be detailed in the rest of the text. It is important to select only those steps that are appropriate for a specifi c case.
Remember the 95% rule – 95% of rhinoplasty articles and lectures deal with the most esoteric 5% of noses, yet 95% of surgeons do not want to do the most diffi cult 5% of noses. This basic rhinoplasty operation is designed to allow the surgeon to do surgery for 95% of primary patients seen by a surgeon in the private practice of aesthetic surgery.
Removal of nasal tampons