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Incisions at the alar base used to narrow the nostrils. There are many ways to reduce nostril size. The larger category term for reduction of nostrils is called alar base reduction. Weir Incisions are the most commonly referred to type of nostril reduction using external incisions.
The incisions are designed to be camouflaged really well inside the grooves of the edge of the nostril where it meets the face.
These are the hairs on the inside of the nose which lie along the edge of the nasal cartilages. These are used for filtration of large air particles, and serve to keep the inside of the nose relatively clean.
These are often trimmed at the beginning of a rhinoplasty to help make the procedure easier.
This is narrowing of the middle third of the nose which can lead to nasal breathing issues. This can be congenital (since birth) or from trauma or previous surgery. Vestibular stenosis repair is the process by which surgeons widen the middle third of the nose, usually by using grafting such as spreader grafts.
The upper paired cartilages. There are two of these in each nose. They are one of two pairs of nasal cartilages in the nose. The other paired cartilages are the lower lateral cartilages. Lateral refers to being on each side of the nose. They are attached superiorly to the nasal bones. Inferiorly, their articulate (interconnected with connective tissue) to the lower lateral cartilages, which are paired as well. The upper lateral cartilages have a lot of effect on breathing. They must be carefully managed during rhinoplasty both for form and shape. If they are not addressed, there may be an undesirable cosmetic or functional outcome.
Horizontal columns of bone and tissue on the inside of the nose. There are three levels: Inferior, middle, and superior. The inferior is the largest of the three, and it is the turbinate most likely to cause nasal obstruction. Turbinoplasty or turbinate reduction is reduction in the size of the inferior turbinate. This is often done during rhinoplasty for breathing purposes. It can be done in a number of ways including outfracture, submucous resection (removing some of the underlying bone), cautery (burning it), etc.
An incision in the septum in front of where it starts inside the nose. This incision is used to access the septum for septoplasty and for harvesting septum to be used in rhinoplasty or vestibular stenosis repair.
An incision through the columellar skin used in open (external rhinoplasty). This incision is between the nostrils and can be placed anywhere, depending on the surgeon’s preference. This is the lower end and connecting incision for the marginal incisions on each side.
The areas of the tip that project the most. There is usually one area on each side of the tip. These points produce a light reflex, which is white in photographs. A good rhinoplasty result has two tip-defining points at a proper distance between each other.
The angle of rotation of the tip. If the tip is too high, this is called an “over-rotated” tip. If the tip is low (ptotic tip), then the nose is “counter-rotated”. Males and females have different degrees of rotation, and also cultural factors must be taken into account when it comes to setting the proper angle for rhinoplasty.
The distance from where the lateral part of the nostril meeting the cheek to the most anterior edge of the tip. The distance of how much the nose projects from the face.
The high point of the lobule. Also synonymous with “lobule”.
The tip of the nose, often referred to as the lobule, plays a crucial role in the overall aesthetics and functionality of the nose. In Beverly Hills, rhinoplasty procedures focusing on the nasal tip are highly sought after for their ability to refine and enhance facial harmony. Dr. Richard Zoumalan, a renowned facial plastic surgeon, specializes in Beverly Hills rhinoplasty tip procedures, offering patients tailored solutions that align with their unique facial features and aesthetic goals.
Understanding the intricacies of the nasal tip is essential for achieving natural-looking results. The tip’s shape, projection, and rotation can significantly impact the nose’s appearance and the face’s overall balance. Dr. Zoumalan employs advanced techniques to ensure that each rhinoplasty is customized to the patient’s needs, whether it’s addressing asymmetry, refining the tip’s contour, or improving nasal function.
Patients can expect a comprehensive consultation process where Dr. Zoumalan evaluates the nasal structure and discusses the desired outcomes. This personalized approach ensures that the results not only meet but exceed expectations, enhancing both appearance and confidence.
For those considering a rhinoplasty tip procedure, Dr. Zoumalan’s expertise and commitment to excellence make him a top choice in Beverly Hills. His practice offers a supportive environment where patient care and satisfaction are paramount. Explore the possibilities of rhinoplasty and discover how a refined nasal tip can transform your look and boost your self-esteem. Contact Dr. Zoumalan’s office today to schedule a consultation and take the first step towards achieving your aesthetic goals.
A straight portion of cartilage taken from the ear for rhinoplasty. It is most often used in secondary, or revision rhinoplasty. The incision can be made in front or in back of the ear, in the ear crease.
This is the area just above the tip. This term is an anatomic location which is specifically discussed and analyzed before surgery and after surgery in many patients. This area can swell after surgery which can be treated with steroid injections.
In some patients, the supratip area retains fullness related to excess cartilage that was left behind.
This is the process of removing cartilage or bone which is underneath mucosa. Mucosa is the inner lining of the nose. So submucous resection refers to elevating the internal lining of the nose to remove either cartilage or bone. Submucous resection is performed for septoplasty, septal cartilage harvest, as well as some types of turbinate reduction (turbinoplasty).
Content: A strut graft is used to strengthen a certain part of the nose. They can be used on the columella which is between the nostrils.
They can also be used on the sides of the nasal valve to strengthen the airway. Typically, they are made from cartilage taken from the septum, ear, or rib.
Nasal septal spurs are sharp bony or cartilaginous bumps along the septum, the wall that divides the two sides of the nose. When a spur sticks into the airway, it can narrow the passage and make breathing feel blocked on one or both sides. Some people also feel pressure or pain right where the spur touches the nasal lining.
Because airflow is disrupted, septal spurs can be linked with ongoing congestion, headaches, and sinus pressure. When the nose doesn’t move air well, the sinus openings may not drain properly, which can lead to repeated sinus infections, post-nasal drip, or facial pain. Snoring or noisy breathing at night can also be related to a spur that is crowding the airway.
To evaluate a possible septal spur, a nasal exam is performed, often with a small camera called an endoscope to clearly see the inside of the nose. Treatment can include medicines that calm inflammation, but structural issues are most reliably treated with surgery. A septoplasty can remove or smooth the spur and straighten the septum to open the airway.
In Beverly Hills, Dr. Richard Zoumalan carefully assesses nasal structure and symptoms to decide whether septal spur surgery is appropriate. His goal is to improve day-to-day breathing, reduce sinus problems, and relieve the discomfort that comes from blockage inside the nose.
Grafts of cartilage placed between the upper lateral cartilages and the septum to widen the middle third of the nose. These graft help with vestibular stenosis as well as prevent depressions/concavity in the middle third of the nose which can be a cosmetic issue. Spreader grafts can also help camouflage a crooked nose as well as deal with asymmetries. They are some of the most commonly used grafts in rhinoplasty and functional nasal surgery (functional rhinoplasty).
On the outside a splint is used after rhinoplasty to keep the bones in place as well as decrease swelling and bruising. If splints are used on the inside after septoplasty, they are used to minimize swelling and decrease healing issues.
The skin area between the alar rim (nostril rim) and the curved border of the junction of the medial and lateral crura. Sometimes, this is well defined, and it is referred to as a facet.
A shield graft is a cartilage graft used in rhinoplasty to improve tip projection and definition. It is placed on the tip of the nose and extends downward to create more structure, helping the tip look stronger, more refined, and better supported. This technique is often used when the nasal tip appears weak, underprojected, or lacks clear shape.
In some patients, a shield graft can also help improve overall nasal balance by giving the tip more presence in relation to the bridge and surrounding facial features. It may be used in primary rhinoplasty or revision rhinoplasty, depending on the patient’s anatomy and surgical goals. Because the nasal tip plays such an important role in facial harmony, even a small graft can make a noticeable difference in the final result.
The size, shape, and placement of the graft are carefully customized to suit the patient’s nose. When performed properly, a shield graft can create a tip that appears more defined without looking overly sharp or unnatural. The goal is to support the nose in a way that improves contour while maintaining a smooth, natural-looking appearance.
For patients considering rhinoplasty in Beverly Hills, understanding how a shield graft works can be helpful when discussing tip refinement and nasal support. Dr. Richard Zoumalan carefully evaluates each nose to determine whether cartilage grafting is needed to achieve better tip projection, improved definition, and a result that looks balanced with the rest of the face.
Very small cartilages found in the space between the upper lateral cartilage and lower lateral cartilages. Their role is still a topic of controversy. They are rarely encountered during rhinoplasty and do not affect surgical plans significantly.
The flat piece of bone and cartilage that separates the right side from the left side of the nose.
The septum is seen below in cross section:
The combination of septoplasty and rhinoplasty. Rhinoplasty can be done on its own. However, when septoplasty is combined with rhinoplasty, it is called septorhinoplasty.
Septorhinoplasty is commonly done when patients want improvement of both the functional (breathing) and aesthetic (cosmetic) aspects of the nose. This is done at the same time because the incisions and approach are shared between the two procedures and the cartilage taken out during septoplasty can be used for structuring in rhinoplasty.
Surgical repair and alteration of the septum. Literally, this term describes reshaping the septum. This is usually done for functional breathing purposes, but sometimes it is done for cosmetic purposes, as the septum is responsible for the deviation of the lower two-thirds of the nose.
Septoplasty can be done using an endonasal technique, which means it can be done with no external incisions. This is the way it is most commonly done. The ways a septoplasty can be done vary greatly.
A graft consisting of cartilage which increases the length of the septum. This is used to change the length of the nose or change the angle of rotation of the nose. This is mostly done during revision rhinoplasty, but also done in some primary rhinoplasties. It can be done either via the open or closed approach.
When the septum is crooked and blocking one side of the nasal cavity, or both. See below how the septum is deviated into the right side in this diagram:
The upper lateral cartilages and lower lateral cartilages interconnect, almost like a handshake. Some noses have more of an interconnection, or scroll. This interconnection is a recurvature of the lateral crus of the lower lateral cartilage as it comes up and over the inferior edge of the upper lateral cartilage.
Saddle nose deformity, characterized by a low nasal bridge, can arise from various causes such as medical conditions, previous rhinoplasty, trauma, or substance use. Dr. Richard Zoumalan, a renowned facial plastic surgeon in Beverly Hills, specializes in saddle nose correction, offering personalized treatment plans to restore both function and aesthetics. His expertise in rhinoplasty ensures that each procedure is tailored to the unique needs of the patient, aiming for natural and harmonious results.
Patients seeking saddle nose correction in Beverly Hills can expect a comprehensive consultation where Dr. Zoumalan evaluates the nasal structure and discusses potential surgical options. The goal is to enhance nasal appearance while improving breathing functionality, which can significantly impact overall quality of life. Dr. Zoumalan’s approach combines advanced surgical techniques with an artistic eye, ensuring that the outcomes are both functional and visually pleasing.
Testimonials from past patients highlight the transformative impact of Dr. Zoumalan’s work. Many report improved breathing, enhanced self-confidence, and a renewed sense of well-being post-surgery. The practice is committed to providing exceptional care, from the initial consultation through to recovery, ensuring a supportive and informative experience.
For those considering saddle nose correction, Dr. Zoumalan’s practice offers a welcoming environment where patient needs and concerns are prioritized. With a focus on achieving optimal results, the team is dedicated to helping patients achieve their desired outcomes. Contact the office today to schedule a consultation and explore the possibilities of rhinoplasty with Dr. Zoumalan.
An incision on the edge of the nostril. This is seldom used in rhinoplasty. Sometimes a small rim incision is made to place a small graft at the nostril edge.
Cartilage grafted from the rib which is used in providing significant structure to the nose. It is most often used in revision rhinoplasty. At times, for noses that need more structure, it can be used in primary rhinoplasty.
Rhinophyma is a condition in which thick, uneven, cyst-like tissue develops over the nose and causes it to become enlarged and distorted. It is commonly associated with advanced rosacea and tends to affect the skin and soft tissue of the nose over time. As the condition progresses, the nose may appear more bulbous, irregular, or heavy due to excess tissue growth and skin thickening.
For many patients, rhinophyma affects both appearance and skin health. The skin may look rough, enlarged, and uneven, with visible pores, redness, and thickened areas that change the normal contour of the nose. In more advanced cases, the excess tissue can become more prominent and may interfere with comfort, hygiene, and overall confidence in social or professional settings.
Treatment for rhinophyma focuses on removing or reshaping the thickened tissue while preserving the natural structure of the nose. Depending on the severity of the condition, treatment options may include laser resurfacing, dermabrasion, or surgical contouring. The goal is to improve the shape of the nose, reduce excess tissue, and create a smoother, more natural surface while addressing the visible effects of rosacea-related skin changes.
For patients concerned about rhinophyma in Beverly Hills, understanding the available treatment options can be an important first step toward improving both appearance and comfort. Dr. Richard Zoumalan carefully evaluates the extent of the tissue changes and nasal contour to determine whether laser, dermabrasion, or surgical treatment may offer the best approach for restoring a more natural nasal shape.
A radix graft is a graft placed to increase the height of the radix, which is the upper part of the nose between the eyes. This is done in rhinoplasty for dorsal height, or bump, management when the starting point of the bridge needs more support or better balance. By adding height to the radix, the bridge can appear smoother and more proportionate without directly changing the tip.
In some patients, the radix sits lower than ideal, which can make a dorsal hump look more prominent than it really is. Rather than only reducing the bump, a surgeon may use a radix graft to improve the transition from the forehead to the bridge and create a more even nasal profile. This approach can help make the nose look softer, more balanced, and better aligned with the rest of the facial features.
Because the radix is such an important part of the profile, even a small change in this area can affect the overall appearance of the nose. The graft must be carefully sized and positioned so the result looks natural and not overly full. When used appropriately, a radix graft can improve contour and support a smoother relationship between the upper bridge and the rest of the nose.
For patients considering rhinoplasty in Beverly Hills, understanding how a radix graft affects dorsal height can be helpful when discussing profile balance and bridge contour. Dr. Richard Zoumalan carefully evaluates the upper bridge and surrounding nasal structure to determine whether a radix graft may help create a smoother profile and a result that looks balanced with the rest of the face.
The junction between the frontal bone and the dorsum of the nose. This is an area that can be deep in some people, requiring a graft during rhinoplasty. Other times, the radix can be too elevated and requires a technique called radix rasping, which reduces the prominence of the radix.
A ptotic tip refers to a nasal tip that hangs downward, decreasing the nasolabial angle between the nose and the upper lip. This can make the nose look longer, heavier, or less refined from the side view. In some patients, the tip may appear droopy all the time, while in others it becomes more noticeable when smiling or with certain facial expressions.
A downward-pointing tip can affect overall facial balance because the nasal tip plays an important role in how the nose relates to the lips, chin, and profile. When the tip lacks enough support or rotates too far downward, the nose may appear less youthful or less proportionate to the rest of the face. This is one of the concerns that may be addressed during rhinoplasty when the goal is to create a more balanced and natural-looking shape.
Correction of a ptotic tip usually focuses on improving tip support, rotation, and projection while preserving a smooth and natural contour. Depending on the patient’s anatomy, treatment may involve reshaping cartilage, reinforcing the nasal framework, or adjusting the angle of the tip to better fit the rest of the nose. The goal is not simply to lift the tip, but to create a result that looks stable, proportionate, and appropriate for the patient’s facial features.
For patients considering rhinoplasty in Beverly Hills, understanding how a ptotic tip affects nasal shape can be helpful when discussing treatment goals. Dr. Richard Zoumalan carefully evaluates tip position, support, and overall nasal structure to determine the best approach for improving a drooping tip and creating a result that looks balanced with the rest of the face.
Deformity caused by fullness in the supratip. The lower portion of the septum is left too high, or if there is redundant scar tissue above the tip, the nose appears as similar to that of a parrot…… “Polly wana cracker?”
The piriform aperture is the bony opening that leads into the nasal cavity. It is pear-shaped and formed by the surrounding maxillary bone, creating the main skeletal entryway into the nose. This structure plays an important role in nasal anatomy because it helps define the lower part of the nasal opening and supports the relationship between the nose and the midface.
In nasal analysis, the piriform aperture is important because its size and shape can affect both appearance and function. A narrow or recessed piriform aperture may influence the way the base of the nose looks and can contribute to reduced support in the surrounding area. It is also a key landmark during facial analysis and surgical planning, particularly when evaluating how the nose relates to the upper lip, nostrils, and central facial structure.
Because the piriform aperture is part of the bony framework, changes in this area can affect the overall balance of the nose and nearby facial features. It may be considered when assessing nasal support, airflow, or structural relationships in more detailed rhinoplasty evaluation. Understanding this area helps give a more complete picture of the anatomy beneath the visible surface of the nose.
For patients considering rhinoplasty in Beverly Hills, understanding the piriform aperture can be helpful when discussing nasal structure and facial balance. Dr. Richard Zoumalan carefully evaluates the underlying nasal framework, including the piriform aperture, to determine how the bony anatomy may affect support, shape, and overall harmony with the rest of the face.
Cuts through bone. There are many types of rhinoplasty osteotomies (medial, lateral, intermediate). In rhinoplasty, osteotomies are used mainly to narrow the nose and straighten the nose.
An open roof deformity happens when a nasal hump is removed but the bones are not brought back together. After the bump is shaved down, the bridge can look too wide. A small gap between the bones may show as a line, groove, or open strip along the top of the nose.
This problem usually occurs when osteotomies, the controlled cuts used to move the nasal bones, are skipped or too conservative. It can also appear after previous surgery or trauma. Once the hump is gone, the space is easier to see and the bridge may no longer flow smoothly from the forehead to the tip.
To correct an open roof, the surgeon repositions the nasal bones to close the gap and narrow the upper bridge. This can include precise osteotomies and, when needed, spreader grafts or dorsal onlay grafts to support the middle vault and improve the bridge shape. As swelling settles, the nose should look smoother and more natural.
Open roof correction is often part of revision rhinoplasty. In Beverly Hills, Dr. Richard Zoumalan evaluates the nasal structure, reshapes or repositions the bones, and closes any visible gaps to create a balanced bridge that fits the nasal tip and facial features.
This is a graft that is used to lift or augment the nose. It can be comprised of cartilage taken from the septum, ear, or rib. This graft lifts the bridge up for cosmetic purposes during primary or revision rhinoplasty.
This is most often done in Asian or African American rhinoplasty where the dorsum (bridge) needs to be built up. There are multiple ways to do this, and sometimes the onlay graft is used to deal with small depressions for camouflage purposes.
When the central part of the nostril peaks upwards. This can be a natural finding for a nostril or it can be a result of over-resection of the lateral cartilages during rhinoplasty.
Some patients like the way this looks, but most are unhappy if there is too much notching. Rhinoplasty surgeons can fix this by using grafts that use cartilage taken from the ear, septum or rib.
The upper part of the pharynx located in the back of the nasal cavity. This area in children sometimes has excess adenoid tissue which can cause nasal obstruction or be contributing to it. This is why during evaluation of people with nasal obstruction, including kids, it’s important to look all the way in the back of the nasal cavity, which may necessitate the use of an endoscope which is a small thin camera that allows you to see this area.
The angle between the lip and columella. If too elevated, then this is called an over-rotated nose. Rhinoplasty surgeons set the tip in the right angle for profile management.
The angle between the nose and the forehead. It is the angle of demarcation between forehead and dorsum of the nose. This is an anatomic location used in analysis of the face, especially on profile views.
It is used to define the overall size and angle of the nose in comparison to the rest of the face. There are typical angles for this.
The thin piece of cartilage and bone which separates the left side from the right side of the nasal cavity. If deviated, this is a deviated septum and can cause nasal obstruction. Septoplasty is the surgery which helps with this.
Nasal obstruction refers to difficulty breathing normally through the nose. It can affect one side or both sides of the nasal airway and may be caused by a range of structural or inflammatory issues. Common causes include a deviated septum, enlarged turbinates, nasal valve collapse, swelling from allergies, or other conditions that narrow the nasal passages and reduce normal airflow.
For many patients, nasal obstruction can become a daily problem that affects comfort, sleep, exercise, and overall quality of life. Some people describe it as constant congestion, while others notice that breathing becomes worse at night or during physical activity. When airflow through the nose is limited, it can also contribute to mouth breathing, snoring, dry mouth, and a feeling that the nose is always blocked.
Evaluation of nasal obstruction usually begins with a careful review of symptoms and a detailed examination of the inside of the nose. This helps identify whether the problem is caused by swelling, an anatomic blockage, or a combination of both. Treatment may include medication when inflammation is involved, but structural problems often require a more targeted approach to improve the airway and restore better nasal breathing.
For patients concerned about nasal obstruction in Beverly Hills, understanding the cause of the blockage is an important part of finding the right treatment. Dr. Richard Zoumalan carefully evaluates the nasal airway and surrounding structures to determine whether septal deviation, turbinate enlargement, valve collapse, or another issue may be affecting breathing, with the goal of improving nasal function and helping patients breathe more comfortably.
The nasal lobule—commonly known as the tip of the nose—plays a vital role in how the face looks and functions. As one of the most noticeable parts of the nose, even small adjustments to its shape or projection can make a big difference in facial balance. In Beverly Hills, Dr. Richard Zoumalan is highly regarded for his expertise in nasal lobule rhinoplasty, helping patients refine their appearance while maintaining a natural, harmonious look that complements their features.
This delicate procedure focuses on reshaping the lower portion of the nose, supported by a complex cartilage framework. Dr. Zoumalan carefully studies each patient’s unique anatomy, including skin thickness, cartilage strength, and nasal symmetry, to plan a tailored approach. His surgical precision allows for subtle improvements to the tip’s contour, rotation, and definition, all while keeping results smooth and proportionate to the rest of the face.
Many patients seek out Dr. Zoumalan to address concerns like a bulbous, drooping, or pinched nasal tip, or to correct uneven contours that affect overall facial aesthetics. Using advanced rhinoplasty techniques, he refines the nasal lobule while preserving or improving breathing function. Recovery is typically straightforward, with swelling subsiding gradually as the new nasal shape settles and refines over time.
With years of experience and an artistic eye, Dr. Zoumalan provides a personalized and supportive experience from consultation through recovery. His Beverly Hills practice is known for achieving balanced, elegant results that enhance confidence and bring out each patient’s natural beauty.
The lower portion of the nose. This is the tip.
The nasal cycle is the natural process in which internal swelling inside the nose alternates from one side to the other. This happens regularly and is normal. Although many people do not notice it, the tissues inside the nose naturally congest and decongest in a repeating pattern, which can make one side feel more open while the other feels slightly more blocked at different times of the day.
This cycle is controlled by the normal function of the nasal lining and blood vessels. As one side of the nose becomes more swollen, the other side typically becomes less swollen, allowing airflow to shift back and forth. In a healthy nose, this is a normal physiologic process and usually does not cause major symptoms. However, patients may become more aware of the nasal cycle if they already have a deviated septum, allergies, turbinate enlargement, or other causes of nasal obstruction.
Understanding the nasal cycle is important because it helps explain why nasal breathing may seem to change throughout the day or night. What feels like sudden congestion on one side is not always a sign of illness or a permanent blockage. In many cases, it is simply the nose moving through its normal cycle. When structural or inflammatory problems are also present, the natural cycle can make those issues feel more noticeable.
For patients concerned about changing nasal airflow in Beverly Hills, understanding the nasal cycle can be helpful when discussing breathing symptoms and nasal function. Dr. Richard Zoumalan carefully evaluates the internal nasal structure and lining to determine whether normal cycling alone is responsible for the symptoms or whether an underlying blockage may also be contributing to difficulty breathing.
The middle third of the nose. This “vault” is important for breathing and cosmetic outcome. If it is too narrowed, it poses a problem with breathing and may create an “Inverted V deformity”.
The most inferior part of the chin on a lateral photo or x-ray. This defines the most bottom part or inferior part of the chin.
This is an anatomic location on the face that can serve importance in facial cosmetic surgery as well as reconstructive surgery. This is taken into account during genioplasty (chin procedures).
This is an incision performed during both endonasal (closed) and external (open) rhinoplasty. This incision is made along the inferior (caudal) border of the lower lateral cartilages to expose the nose for rhinoplasty.
These are one of two sets of paired cartilages in the nose. The others are the upper lateral cartilage. The lower lateral cartilages determine the shape of the tip. There is one lower lateral cartilage on each side of the tip. Tip rhinoplasty or tip-plasty is shaping the tip by mostly reshaping these cartilages, although other factors such as the septum and soft tissue are also involved.
Cuts in the bone made with an osteotome (similar to a chisel) to create small fracture to allow the nasal bones to move. This is used to narrow a nose and/or straighten it.
An L-strut is the remaining structure after the central portion of the septal cartilage has been removed. Leaving a strong L-strut is the goal in septoplasty and septal cartilage harvest, because adequate cartilage must be left on the top, or dorsal portion, and the caudal portion near the columella to support the whole structure of the nose. This remaining cartilage forms an L-shaped support beam that helps maintain both nasal shape and stability.
In nasal surgery, the septum does more than separate the two sides of the nose. It also provides important structural support for the bridge and tip. If too much cartilage is removed during surgery, the nose can lose support and become weaker over time. This is why preserving a strong L-strut is such an important part of careful surgical planning, especially when cartilage is being harvested for grafting or when the septum is being reshaped.
A stable L-strut helps maintain the height of the bridge, the position of the tip, and the overall integrity of the nasal framework. It also plays a role in preserving normal airflow through the nose. When this support is properly maintained, it reduces the risk of collapse, deformity, or functional problems after surgery. Even though it is an internal structure, it has a major effect on both the appearance and function of the nose.
For patients considering rhinoplasty or septoplasty in Beverly Hills, understanding the role of the L-strut can be helpful when discussing structural support and long-term nasal stability. Dr. Richard Zoumalan carefully evaluates the septal framework and preserves adequate cartilage support to help maintain nasal function, protect the structure of the nose, and create a result that remains balanced over time.
A wire used to stabilize the structure of a nose during healing. An internal stabilization technique, often used for rib cartilage grafts.
An incision used for septoplasty and septal cartilage harvest. It is placed just beyond where the septum starts and is less destabilizing than a hemitransfixion or full transfixion incision.
The point where the septum joins the nasal bones and the upper lateral cartilage. This point can be found in the midline of the nose, just caudal (below) the central edge of the nasal bones. This area must be carefully maintained during rhinoplasty.
Kenalog is a steroid medication whose medical name is triamcinolone acetonide. In rhinoplasty care, Kenalog injections are sometimes used after surgery to help reduce swelling and soften scar tissue as the nose heals. This can be especially helpful in areas where swelling lasts longer or where thicker skin makes the definition of the nasal tip slower to appear.
After rhinoplasty, healing does not happen at the same pace in every part of the nose. Some patients may develop persistent fullness, firmness, or scar-related thickness that affects the way the result settles over time. In these cases, Kenalog may be used selectively to help calm excess tissue response and support a smoother healing process. The goal is to improve contour without interfering with the natural recovery of the nose.
Because postoperative swelling can change the appearance of the nose for months, careful follow-up is an important part of rhinoplasty treatment. Kenalog is not used in every case, and the timing, dosage, and location of the injection must be chosen with care. When used appropriately, it can help refine the result and reduce the effects of prolonged swelling or scar formation.
For patients recovering from rhinoplasty in Beverly Hills, understanding how Kenalog may be used during healing can be helpful when discussing postoperative care. Dr. Richard Zoumalan carefully monitors the healing process to determine whether Kenalog injections may help reduce swelling, soften scar tissue, and support a more refined final result.
If the middle third of the nose (middle vault) is collapsed, the edges of the nasal bones can show. They create a shadow similar to an upside down V. This is usually the result of reducing the nasal bridge and not supporting the middle third. This is prevented by supporting the middle third with grafts such as spreader grafts.
An important structure for breathing. This is an area inside the nose where the septum meets the upper lateral cartilages. This valve cross sectional area affects breathing significantly. Dr. Zoumalan has done a study on how rhinoplasty affects the cross sectional area of the internal nasal valve. This landmark study showed that if the internal nasal valve is treated properly, rhinoplasty can maintain or improve breathing consistently.
An incision that goes between the bottom edge of the upper lateral cartilage and upper edge of the lower lateral cartilage. This approach is used in rhinoplasty to access the dorsum.
The part of the lobule (midline tip of nose) between the most anterior tip-defining point and the top of the columella. This cosmetic area is important in management during rhinoplasty.
A hump is another word for a bump or high dorsum on the bridge of the nose. It can vary in size and shape, with some humps appearing as a subtle raised contour and others creating a more noticeable prominence along the nasal profile. Depending on the patient’s anatomy, a hump may be made up of bone, cartilage, or a combination of both.
For some patients, a nasal hump can make the bridge look stronger or more projected than desired, which may affect overall facial balance. It is often one of the most common concerns discussed during rhinoplasty consultation, especially by patients who want a smoother side profile. In some cases, reducing a hump may also help create a more natural transition from the forehead to the tip of the nose.
During rhinoplasty, hump reduction is performed with careful attention to the surrounding nasal structures. The goal is not simply to remove the bump, but to reshape the bridge in a way that looks smooth, proportionate, and natural. Because the bridge plays such an important role in nasal appearance, even a small adjustment can make a significant difference in the final result.
For patients considering rhinoplasty in Beverly Hills, understanding how a nasal hump affects the overall shape of the nose can be helpful when exploring treatment options. Dr. Richard Zoumalan carefully evaluates the bridge and surrounding nasal structure to determine the best approach for hump reduction, with the goal of creating a smoother profile and a result that looks balanced with the rest of the face.
A hemi-transfixion incision is an incision on one side of the septum used to perform a septoplasty or to obtain cartilage for cartilage grafting.
Unlike a full incision transfixion, a hemi-transfixion doesn’t go through the full membranous septum. Therefore, it affects the support of the tip much less than a full transfixion incision.
The columella is located between the nostrils. When it hangs significantly lower than the nostrils, this is called hanging columella.
A hanging columella curves downwards towards the lips. This is something that patients are typically looking to improve and make less prominent during primary rhinoplasty as well as revision rhinoplasty. Great improvement in all angles can be made with improving a hanging columella and making a more straight columella that doesn’t hang as much.
Changing the shape of the chin either by augmenting (making it bigger) or reducing the size of the chin. Genio is the Latin term for the chin. Plasty is the Latin term for changing the shape of.
Chin augmentation can be done with either filler or a chin implant. It can also be done by making bony cuts in the anterior part of the chin and sliding it forward or backwards. It can be done in really any number of ways to both the soft tissue and bone.
The portion of the face between the eyebrows. This anatomic area is found directly above the root of the nose. It is used in analysis of the nose for rhinoplasty as well as generally for facial analysis.
This is an area that can be augmented with filler. This is also an area that can develop wrinkles, and botox can help with this.
Facial analysis the process of analyzing a face in every dimension. This can be done in a variety of ways, and there is no consistent way to do this. Every surgeon is different in the way that they both analyze the face, and this is based on both their training/knowledge and their general sense of taste of ideal facial features. Facial analysis is integral to the initial meeting with a facial plastic surgeon.
A horizontal plane extending through the lateral facial profile with the head in a normal relaxed position. If an imaginary line were drawn from the ear canal to the area just under the eye (infraorbital rim), this should be parallel to the ground. This is a neural natural horizontal facial plane. Before and after photos are taken with people’s heads in this neutral position.
In photos, this is the view from the front. This is used to analyze over facial symmetry, dorsal deviation, the curves of the facial features, skin, cheekbone height, and it is integral in the analysis of a nose to determine if the nose is straight, has symmetry, is drooping, and how much nostril shows from the front.
A type of incision to access the septal cartilage for septal cartilage. It is done at the front of the septum where access is the closest to the surgeon. If it is only done on one side, this is a hemi-transfixion incision. If it is done on both sides, it is a full transfixion incision.
Both of these incisions can cause weakening of the nasal tip support, so this has to be taken into account during rhinoplasty to ensure that the tip will have proper support after rhinoplasty.
Swelling. Edema is a normal part of rhinoplasty and revision rhinoplasty recovery. Some rhinoplasty patients experience more edema than others.
Rhinoplasty performed with all incisions inside the nose. There is no incision on the columella (incision between the nostrils).
Epistaxis is a medical term for nosebleed. Epistaxis can occur after surgery within the first couple weeks. It often occurs because patients exercise or get their blood pressure increased after surgery. However, it can happen even in the absence of this.
Epistaxis also occurs a lot in children and adults due to exposed small blood vessels. Often compression of the front of the nose can help with bleeding, but we DO NOT RECOMMEND THIS for patients who have had rhinoplasty. Call your surgeon if you have excessive bleeding.
Nostril opening. Along with the internal nasal valve, this area is important for breathing. Nasal surgeons need to evaluate the strength of this area. Modified Cottle maneuvers during your exam can help determine the strength of this area. Rhinoplasty must take into account the strength of this valve.
External rhinoplasty, also known as open rhinoplasty, is a surgical technique that gives the surgeon a clear view of the nose’s internal structure. This approach is often chosen for patients who need more detailed or complex adjustments, such as reshaping the nasal tip, correcting asymmetry, or refining the bridge. In Beverly Hills, Dr. Richard Zoumalan is widely recognized for his expertise in performing open rhinoplasty procedures that deliver precise, natural-looking results.
Unlike closed rhinoplasty, which is performed entirely through internal incisions, the open technique involves a small incision along the columella—the narrow strip of skin between the nostrils. This allows Dr. Zoumalan to directly visualize and adjust the underlying bone and cartilage with greater accuracy. The incision is only a few millimeters long and typically heals with minimal to no visible scarring.
Recovery from open rhinoplasty is straightforward for most patients. Swelling and mild bruising are normal in the first few days, but most people return to work within a week. Dr. Zoumalan provides detailed aftercare instructions to help ensure proper healing and the best cosmetic outcome.
For those considering nasal surgery that requires structural refinement or revision, Dr. Zoumalan’s open rhinoplasty approach offers precision, predictability, and long-lasting results that enhance both appearance and confidence.
Top of the nose, from the top of the tip to the glabella (between the eyebrows). When the dorsum is high, this is called a “bump” or a “hump”. Management of the dorsum is one of the key aspects during rhinoplasty. Some want a straight dorsum (no hump or scoop). Others want to maintain a small amount of elevation of dorsum. Communication between you and your rhinoplasty surgeon is key to having your aesthetic goals realized.
Dorsal reduction refers to lowering the top of the nose by reducing a hump or bump along the bridge. This area, known as the dorsum, plays a major role in the side profile, and even a small prominence can make the nose appear stronger or more projected than desired. Dorsal reduction is used to create a smoother bridge contour without directly changing the nasal tip.
In rhinoplasty, dorsal reduction may involve adjusting bone, cartilage, or both, depending on what is creating the hump. The goal is not simply to remove height, but to reshape the bridge so it looks balanced and natural in relation to the rest of the nose and face. Careful planning is important because changes to the bridge can affect the overall nasal shape, profile, and structural support.
When the dorsum is lowered, the surrounding nasal framework may also need to be addressed to maintain smooth lines and proper function. This can include refining the bridge contour and making sure the nose continues to look proportionate from both the front and side views. A well-performed dorsal reduction can soften the profile while preserving a natural appearance.
For patients considering rhinoplasty in Beverly Hills, understanding how dorsal reduction affects the shape of the bridge can be helpful when discussing treatment goals. Dr. Richard Zoumalan carefully evaluates the nasal dorsum and surrounding structure to determine the best approach for lowering a hump, creating a smoother profile, and achieving a result that looks balanced with the rest of the face.
A piece of cartilage or other material used to make the dorsum bigger. Also known as dorsal augmentation.
Dorsal deviation is another name for crooked nose. The dorsum is the top of the nose. Deviation means crookedness. Dorsal deviation is therefore having a crooked nose.
This is something that can be helped with proper rhinoplasty techniques. Dorsal deviation improvement is one of the most complex things in rhinoplasty. The amount of improvement will depend on the amount of healing as well.
Dorsal augmentation is building the bridge up during rhinoplasty. This can be done surgically with permanent cartilage or fascia grafts, with implants like silicone, implants using irradiated cartilage or dermis (skin), as well as the use of fillers like Restylane, Voluma, or Juvederm.
Building up a bridge is very common for certain ethnic groups like Asians and African Americans. It is sometimes also done in revision rhinoplasty when too much of the bridge was taken off previously.
A donor site is the area where cartilage is taken from for use during rhinoplasty or reconstructive nasal surgery. If rib grafting is performed, the donor site is the rib. In other cases, cartilage may be taken from the septum inside the nose or from the ear, depending on how much support or graft material is needed for the procedure.
In rhinoplasty, cartilage grafts are often used to build structure, improve support, or reshape certain parts of the nose. The choice of donor site depends on the patient’s anatomy, the amount of cartilage required, and the surgical goals. Septal cartilage is often preferred when available, but in more complex cases, especially revision rhinoplasty, ear or rib cartilage may be needed to provide enough material and strength.
Because each donor site has different qualities, the surgeon carefully chooses the source that best fits the needs of the operation. Septal cartilage is generally straight and firm, ear cartilage is softer and more curved, and rib cartilage provides a larger amount of material when major reconstruction is required. Understanding the donor site is important because it is part of the overall surgical plan and can affect both healing and structural support.
For patients considering rhinoplasty in Beverly Hills, understanding the role of the donor site can be helpful when discussing cartilage grafting and surgical planning. Dr. Richard Zoumalan carefully evaluates whether septal, ear, or rib cartilage is the most appropriate source for grafting, with the goal of creating strong support, natural contour, and a result that looks balanced with the rest of the face.
An old tip rhinoplasty technique whereby the cartilages of the tip are split. This helps create definition and narrows the tip. This technique has fallen out of favor, given its relatively high rate of unsatisfactory cosmetic results. Some surgeons still perform this.
Exposing the lower lateral cartilages via an endonasal (closed) approach. This is used to expose the tip so that tip contouring can be performed.
Lateral or medial. Lateral crus are the wings of the tip. Medial crus make up the structure of the columella, which is cartilage and soft tissue between the nostrils.
Physical maneuvers used to test breathing before and after nasal surgery. This is a subjective measure of how good breathing is on each side. When the cheek is pulled away from the nose, patients are asked how much their breathing score improves. This gives an idea of whether vestibular repair can help with breathing. This is part of a functional rhinoplasty consultation.
A rib graft. A portion of rib taken as a graft. This is done in some revision rhinoplasties.
Costal cartilage rib graft rhinoplasty is a specialized procedure often utilized in revision rhinoplasties to address complex nasal reconstruction needs. This technique involves harvesting a portion of the rib, known as costal cartilage, to serve as a graft. The use of rib cartilage is particularly beneficial due to its robust structure, which provides the necessary support and shape for the nose, especially in cases where previous surgeries have depleted other cartilage sources.
Dr. Richard Zoumalan, a renowned facial plastic surgeon based in Beverly Hills, is highly skilled in performing this intricate procedure. His expertise ensures that patients receive natural-looking results that enhance both the aesthetic and functional aspects of the nose. Patients who have undergone costal cartilage rib graft rhinoplasty with Dr. Zoumalan report significant improvements in nasal structure and breathing, contributing to an overall enhanced quality of life.
Choosing a surgeon with extensive experience in costal cartilage rib graft rhinoplasty is crucial for achieving optimal outcomes. Dr. Zoumalan’s meticulous approach and commitment to patient care make him a trusted choice for those seeking revision rhinoplasty. His practice offers a comprehensive consultation process, allowing patients to understand the benefits and expectations of the procedure fully.
For individuals considering this procedure, Dr. Zoumalan’s office provides detailed information and personalized care plans to address specific needs. Contact the office today to schedule a consultation and explore how costal cartilage rib graft rhinoplasty can help achieve your desired results.
Cartilage grafted from the ear. The concha is the bowl of the ear just outside of the ear canal. It is curved and can be used to reconstruct the lateral crura.
When the lateral crura bow into the nasal cavity. This can cause breathing and cosmetic issues. Sometimes, this is a result of previous rhinoplasty.
The angle formed between the columella and the lip. This angle is really important for profile management. Rhinoplasty surgeons have to know the exact angles.
A graft which extends from the columella and all the way to the anterior portion of the nasal tip. This provides tip projection, definition, and tip support.
Columellar show is used to describe a gap between the columella (the part of the nose between the nostrils which resembles a column) and the nostril edge. If the amount of “show” of this gap is more than about 2 mm from the profile view, then this begins to show too much of the inside of the nose from the profile view. So this is termed excess columellar show.
This is a complex situation to improved and requires the use of grafting and tip reshaping maneuvers to improve. Often patients complain about increased columellar show if a reductive rhinoplasty was done that doesn’t take into account the necessary structures that need to be respected during rhinoplasty.
The midline column of nose between the nostrils. It is composed of skin, soft tissue, and cartilage. This is the location of the incision for external (open) rhinoplasty.
A collapsed nose due to long-term, heavy cocaine use. The cocaine breaks down the soft tissue, cartilage, and the bone as well. Patients with this problem have a nose that is flattened, does not breathe well, bleeds often, and has tremendous crusting. Sometimes the erosion can even include the roof of the mouth (palate). Nasal reconstruction requires complex grafting and usually required rib cartilage graft with total reconstruction of the L-strut.
Rhinoplasty performed with all incisions inside the nose. There is no incision on the columella (incision between the nostrils).
Patients with cleft lips often have abnormal nasal anatomy which requires rhinoplasty. The nose usually sways to one side, and the cartilages are mis-shaped.
Continued, regular sinus infections. There are certain medical criteria that patients have to meet in order to be given this diagnosis.
Cephalic rhinoplasty, a specialized procedure offered by Dr. Richard Zoumalan in Beverly Hills, focuses on enhancing the upper part of the nose, which is directed towards the top of the head. This technique is ideal for individuals seeking a refined nasal appearance while maintaining a natural look. Dr. Zoumalan, a renowned facial plastic surgeon, combines his artistic skills with advanced surgical techniques to deliver exceptional results tailored to each patient’s unique facial structure.
Patients who have undergone cephalic rhinoplasty with Dr. Zoumalan report significant improvements not only in aesthetics but also in nasal function. Enhanced breathing and a more balanced facial profile are common outcomes, contributing to overall well-being and confidence. Dr. Zoumalan’s meticulous approach ensures minimal scarring and a swift recovery, allowing patients to resume their daily activities with ease.
Trust in Dr. Zoumalan’s expertise is reinforced by numerous testimonials from satisfied clients who have experienced life-changing transformations. His commitment to patient care and attention to detail is evident in every procedure, making him a top choice for those seeking cephalic rhinoplasty in Beverly Hills.
For those considering this procedure, Dr. Zoumalan offers comprehensive consultations to discuss individual goals and expectations. His personalized approach ensures that each patient receives a treatment plan that aligns with their aesthetic desires and functional needs. Explore the possibilities of cephalic rhinoplasty and discover how it can enhance your natural beauty and improve your quality of life. Contact Dr. Zoumalan’s office today to schedule a consultation and take the first step towards achieving your desired look.
Inferior when referring to the nose.
Caudal rhinoplasty is a specialized procedure focusing on the lower part of the nose, often referred to as the caudal septum. This technique is crucial for patients seeking to enhance nasal aesthetics while improving functionality. Dr. Richard Zoumalan, a renowned facial plastic surgeon in Beverly Hills, offers expert caudal rhinoplasty services, ensuring natural and harmonious results tailored to each patient’s unique facial structure.
Patients who undergo caudal rhinoplasty with Dr. Zoumalan often report significant improvements in both appearance and nasal function. The procedure can address issues such as a drooping nasal tip, asymmetry, or breathing difficulties, providing a comprehensive solution that enhances overall quality of life. Dr. Zoumalan’s meticulous approach and artistic eye ensure that each surgery is customized to achieve the best possible outcome.
Testimonials from satisfied patients highlight the transformative impact of Dr. Zoumalan’s work. Many have experienced not only aesthetic improvements but also enhanced breathing and overall health benefits. For instance, patients have noted better sleep quality and increased exercise capacity post-surgery, underscoring the procedure’s holistic benefits.
For those considering caudal rhinoplasty, Dr. Zoumalan offers consultations to discuss individual goals and expectations. His practice in Beverly Hills is equipped with state-of-the-art technology, ensuring a safe and comfortable experience. With a commitment to excellence and patient satisfaction, Dr. Zoumalan is a trusted choice for those seeking top-tier rhinoplasty services.
Explore the possibilities of caudal rhinoplasty and discover how it can enhance your facial harmony and well-being. Contact Dr. Zoumalan’s office today to schedule a consultation and take the first step towards achieving your desired look and improved nasal function.
A graft comprised of cartilage which is placed on the end of the septum to extend, rotate, or counter-rotate the tip, among other purposes.
The caudal septum plays a crucial role in rhinoplasty, particularly in addressing nasal structure and function. Located at the inferior border of the septum, it interacts with the medial crura of the cartilages, influencing both the aesthetic and functional aspects of the nose. A well-executed caudal septum rhinoplasty can significantly improve nasal symmetry, enhance breathing, and adjust the nasal tip’s position, whether it sits too high or too low.
Dr. Richard Zoumalan, a renowned facial plastic surgeon based in Beverly Hills, specializes in this intricate procedure. His expertise ensures that patients not only achieve their desired aesthetic outcomes but also experience improved nasal function. Many patients report enhanced breathing and a better quality of life post-surgery, as seen in testimonials from satisfied clients.
For those considering caudal septum rhinoplasty, Dr. Zoumalan offers a comprehensive consultation process. This includes a detailed assessment of nasal anatomy and a discussion of the patient’s goals. The procedure is tailored to each individual’s needs, ensuring natural-looking results that harmonize with the patient’s facial features.
Patients can expect a thorough explanation of the procedure, recovery process, and potential outcomes. Dr. Zoumalan’s commitment to patient care and his meticulous approach to surgery have earned him a reputation for excellence in the field of rhinoplasty.
To learn more about how caudal septum rhinoplasty can benefit you, explore our patient resources or contact our office to schedule a consultation. Our team is dedicated to providing exceptional care and helping you achieve the best possible results.
