Tip surgery in rhinoplasty is very important in the good esthetic outcome of this surgery.

Nasal tip surgery is an important and the most prominent side of the septorhinoplasty prosedure. To define my tip surgery steps and my way of achieving attractive and natural looking tip, I aimed to define my surgical tips.

Rhinoplasty is becoming more and more popular worldwide. Male nose is more challanging compared to female nose dur to the difficulty to get a satisfying and natural result. Surgeon has to make a very accurate preoperative analysis, understand very well the patients’ expectations, evaluate these expectations are realistic or not, and master different surgical methods to achieve a good result.

In an era of dorsal preservation rhinoplasty, the role of spreader grafts may become overlooked. However, spreader grafts have several important aesthetic effects and may be advantagous in many different rhinoplasty scenarios. As so, spreader grafts should certainly be considered in many - if not in most - rhinoplasty cases, both primary and revision.

Conditions to be considered in rhinoplasty specific to age group

Description:  Preservation rhinoplasty has been a hotly debated approach to rhinoplasty with some highly touted benefits for patients.  Certain techniques within preservation rhinoplasty, namely the low strip technique allows for powerful adjustment of septal alignment and support.

Outcome: To illustrate the utility of low strip dorsal preservation in the case of the severely deviated septum to maximize functional improvement. This talk aims to review index cases illustrating the benefits and nuances of low strip dorsal preservation techniques for the severely deviated septum.

Discussion and conclusions: The low strip dorsal preservation technique allows for unmatched straightening of the nasal septum, including high bony components at the bony- cartilaginous junction as well as severe caudal deviations or caudal excess.  This can be done without changes to the external nose or can be coupled with cosmetic techniques.

Management of nasal valve collapse following rhinoplastic surgery

nasal valve collapse (NVC) is a frequent, yet often overlooked, complication following rhinoplasty. It affects both the internal and external nasal valves and can lead to persistent nasal obstruction despite an otherwise successful cosmetic outcome. NVC is a significant and often underdiagnosed cause of postoperative nasal obstruction following rhinoplastic surgery. The incidence of NVC post-rhinoplasty is estimated at 10–15%, though this may be underestimated due to variability in diagnostic practices.

the nasal valve area, comprising the narrowest segment of the nasal airway, is highly susceptible to both static and dynamic collapse, particularly after structural alteration during cosmetic or functional rhinoplasty. Post-rhinoplasty NVC may result from structural weakening due to excessive cartilage resection, inadequate support of the lateral nasal wall, or failure to reinforce the internal valve. As the nasal valve area is critical to regulating airflow resistance, even minor structural changes can result in significant functional impairment.

the management strategy for NVC involves primarily prevention in the original operation. If occurs postoperatively, objective and subjective diagnostic methods, such as visual analog scale (VAS) for patient-reported nasal obstruction, peak nasal inspiratory flow (PNIF) measurements, modified cottle tests, nasal endoscopy, and digital imaging or anatomical assessment are used for definite diagnosis. Non-surgical methods are tried namely, the use of external nasal dilators strips, trial of internal nasal stents or nasal valve dilators and medical therapy (nasal corticosteroids, antihistamines) to optimize mucosal condition. These modalities, while non-invasive, are often insufficient or poorly tolerated by some patients due to comfort or cosmetic concerns.

surgical correction methods may include the use of spreader grafts, alar batten grafts, and suspension techniques, tailored to the type and severity of the valve collapse. Alar batten grafts can improve the NVC, but cause the nose look less elegant and broad. Moreover, some patients feel uncomfortable due to graft rigidity on the nasal side walls.

alternatively, nasal valve suspension sutures have shown promise in addressing both internal and external NVC without compromising nasal appearance. This technique does not require cartilage grafts, avoiding donor site morbidity, utilizes a minimally invasive endonasal approach, and involves placement of one or two 4-0 or 5-0 PDS sutures in a horizontal mattress configuration to support the lateral nasal wall.

this surgical technique is indicated for patients presenting with persistent nasal obstruction secondary to valve collapse following primary rhinoplasty. Exclusion criteria include unresolved septal deviation, turbinate hypertrophy unrelated to valve dysfunction, or active sinonasal disease. Patients were followed for a minimum of six months.

postoperative outcomes were assessed using VAS scoring for subjective improvement, PNIF measurements for objective airflow assessment, modified cottle test and nasal endoscopy, and photographic documentation to evaluate maintenance of aesthetic outcomes.

nasal valve suspension sutures represent an effective and cosmetically favorable surgical option for managing NVC after rhinoplasty. This technique provides effective relief of nasal obstruction without compromising the external nasal appearance, making it a valuable alternative to traditional graft-based procedures in appropriately selected patients.

to discuss the red flags to choose patients in rhinoplasty

modern rhinoplasty requires a profound understanding of the complex anatomy of the nose, including the interaction of bony, cartilaginous, and soft tissue structures. The evolution of surgical approaches aims to preserve airway functionality while achieving an aesthetically harmonious outcome.

to analyze current concepts of the complex nasal anatomy and its influence on rhinoplasty techniques aimed at improving both aesthetics and functionality.

the study is based on the analysis of anatomical data, clinical observations, and a comparative evaluation of surgical techniques. Computed tomography, 3d modeling, and statistical data processing were employed for patients who underwent rhinoplasty. The study included 50 participants (30 women and 20 men) who underwent rhinoplasty for aesthetic and functional indications between january 2024 and february 2025.

patient examinations were performed preoperatively, and subsequently at 1, 3 months, and 1 year postoperatively. The assessment included patient complaints and medical history, laboratory tests according to nosological standards, standard ENT examination, specific functional nasal valve tests (“push-up” test, cotton ball test, cottle maneuver) and endoscopic evaluation of the nasal cavity. Statistical analysis was performed using IBM SPSS statistics software.

analysis of 50 rhinoplasty cases revealed that nasal anatomical features play a key role in determining the surgical technique and predicting outcomes. The main findings include:

1.       individual anatomical variations.

72% of patients demonstrated anatomical characteristics that influenced preoperative planning and surgical techniques. The most significant variations included:

• variability in the shape and thickness of the osteocartilaginous framework.

• differences in the angle of nasal septal deviation.

• various attachment types of the medial crura of the alar cartilages.

• variations in the structure of the lateral cartilages affecting airway patency.

• differences in subcutaneous fat layer thickness determining contour modeling complexity.

key external nasal features in the kazakh population include:

• thick nasal tip skin with a pronounced subcutaneous fat layer.

• low and wide dorsum with a poorly defined cartilaginous hump.

• broad nasal tip.

• hypoprojection of the tip.

• wide alar base.

• closed v-shaped nostril type.

2.       influence of anatomical features on surgical techniques.

in 85% of cases, surgeons emphasized the importance of considering individual anatomy to achieve optimal outcomes. Analysis of surgical procedures identified the following challenging zones:

• osteocartilaginous junction of the nasal dorsum – high risk of deformities during resection.

• alar cartilages – critical for maintaining the aesthetic form of the nasal tip.

• nasal septum – its condition determines the possibility of complete functional correction.

• soft tissue thickness – patients with thick skin present greater difficulty in achieving a well-defined contour.

rhinoplasty based on detailed study of nasal anatomy allows minimization of postoperative complications and improvement in the predictability of aesthetic outcomes. Modern technologies, including 3d analysis and computer modeling, contribute to increased precision in surgical interventions.

Description: rhinoplasty surgeons often find that despit their best efforts to straighten the nose, patients ofte continue to perceive their nose as deviated, and this perception is particularly prevalent in patients with concurren facial asymmetry. We can do a 7 minutes presentation on this topic

outcome objectives: we want to raise awarenes about the facial assymmetry before rhinoplasty

backgorund: this subject has been published as a paper: awareness of facial asymmetry and its impact on postoperativ satisfaction of rhinoplasty patientawareness of facial asymmetry and its impact on postoperativ satisfaction of rhinoplasty patient