The evolution of open structure rhinoplasty.

Modifications and innovations in open structure rhinoplasty that have occurred as this technique has evolved are discussed. In addition, the philosophy and fundamentals of open structure rhinoplasty are reexamined. A retrospective review of representative patients in a private practice setting was performed. All surgical procedures were conducted in a freestanding private surgery center. The preoperative and long-term results of each patient are compared to demonstrate the effectiveness of the described techniques. The fundamental philosophy of open structure rhinoplasty is the maintenance of the integrity and strength of the nasal skeleton. Modifications of tip grafting techniques, along with additional domal grafting techniques, and a stronger focus on domal suturing techniques result in a softer contour and lack of tip tensions while maintaining structural support.