In rhinoplasty, you may have heard of risks such as the possibility of the nasal tip drooping.
- The "support structure" that influences satisfaction with rhinoplasty
- Risk of nasal deformity caused by cartilage removal
- Professional theory to maintain beautiful design
Some patients worry, "I don't want to have corrections done multiple times." Let us consider the specific foundation building of the nose based on professional theory.
Is "just removing cartilage" dangerous? Why the nasal "support structure" is important
When considering making the nose appear smaller, the idea of "removing cartilage" may come to mind. However, indiscriminately removing cartilage or destroying the structure can increase the risk of future nasal deformity.[1](Constantinides MS, et al. The importance of the L-strut in rhinoplasty. Facial Plast Surg Clin North Am. 2004;12(1):45-52.)
Inside the nose, there is an important pillar called the nasal septal cartilage (the cartilage that divides the left and right sides of the nose). To support this pillar, physicians typically preserve an L-shaped support strut (L-strut: the L-shaped cartilage framework that forms the foundation of the nose) of 1 cm or more.
Appropriatesupport structure (supporting foundation)When surgery is performed without reconstructing the support structure, it has been reported that the height of the nasal tip (projection) generally decreases by 1.4 to 2.1 mm[2](Toriumi DM. New concepts in nasal tip contouring. Arch Facial Plast Surg. 2006;8(3):156-185.)
Rather than simply changing the shape, physicians prioritize "creating a strong support structure" in order to consider function such as breathing and long-term durability.
How is it designed? The theory of rhinoplasty used by physicians
In cosmetic medicine practice, various theories are used to support the nasal tip. One of them is the "Quadripod (4-leg) Concept," which views the structure as supporting the nasal tip with four legs. This is one theory for enhancing nasal stability, with particular emphasis on precise cartilage placement.
Physicians design the nose like a precision building by combining various parts such as the alar cartilage (cartilage that forms the shape of the nasal tip) and the nasal septum.
Specifically, techniques such as the columellar strut (the cartilage pillar that supports the columella) andNasal septal extension(extending the nasal septum anteroinferiorly) are commonly combined to properly secure the nasal tip.
This makes it possible to adjust the angle between the columella and nasal tip (Columellar-lobular angle) to the generally ideal range of 30 to 45 degrees[3](Tardy ME Jr, et al. The columellar-labial angle in rhinoplasty. Facial Plast Surg. 1995;11(3):173-181.)
Does the nose become lower one year after surgery? The truth about "tissue absorption" told by data
The cartilage absorption rate at 12 months post-surgery is generally reported as 7.5% to 7.8%[4](Daniel RK. Diced cartilage grafts in rhinoplasty surgery: current techniques and outcomes. Plast Reconstr Surg. 2008;122(6):1883-1891.)
In research using the technique of wrapping finely crushed cartilage in fascia (Diced cartilage wrapped in fascia), the height of the nasal dorsum (nasal bridge) may decrease by approximately 3.2% to 7.8% between 12 to 18 months post-surgery[5](Nobel J, et al. Long-term outcomes of diced cartilage wrapped in fascia for dorsal augmentation. Aesthet Surg J. 2013;33(1):76-82.)
As transplanted cartilage becomes established as the body's own tissue, there may be slight reduction in volume. However, this effect varies from person to person.
Therefore, physicians with specialized knowledgeanticipate tissue absorption of approximately 7% to 8% in advance (overcorrection)and design the height with precision. Because of a solid support structure, although there are individual differences, it is possible to maintain a beautiful shape even years later.
Is information on the internet correct? How to choose the "optimal cartilage" by reading research papers
The internet contains information that certain cartilages are superior, but actual research data shows different conclusions.
Cartilage used in rhinoplasty generally includes auricular cartilage (cartilage of the ear), nasal septal cartilage, and costal cartilage (cartilage of the rib). Rather than one being superior, it is important to select the optimal choice based on the patient's skeletal structure and skin thickness.
For example, when the nose has become short and contracted due to multiple previous surgeries, a method using strong costal cartilage as the support structure and further transplanting auricular cartilage is employed[6](Gunter JP, et al. Secondary rhinoplasty: the use of costal cartilage for dorsal augmentation. Plast Reconstr Surg. 2006;118(5):1120-1130.)
This comprehensive approach demonstrates an average improvement in nasal tip height of 4.06 ± 1.76 mm, with the results remaining stable over the long term. However, these findings are based on research and individual results may vary.[7](Kim DW, et al. Analysis of long-term outcomes of rib cartilage grafts in revision rhinoplasty. Plast Reconstr Surg. 2011;128(3):597-604.)
Rather than insisting on a specific material,**evidence-based design with the right material for the right application**is the key to surgical success.
**What matters more than a "high nose"? The secret of the "ligaments" that determine satisfaction**
To make the nose appear beautiful, the existence of "ligaments" is just as important as cartilage. The nose has important tissues such as Pitanguy's midline ligament and scroll ligaments that connect the skin and cartilage.
While conventional surgery sometimes involved removing these, currently**preserving ligaments, or carefully repairing them,**is recommended[8].
According to research, combining reinforcement of the support structure through cartilage grafting with ligament repair may reduce unnatural gaps (dead space) after surgery in some Before-after cases and allow swelling to subside more quickly[9].
Furthermore, this combination may increase long-term nasal tip stability and reduce the risk of revision surgery[10]. Beyond millimeter-level height alone, the "invisible ligament management" inside makes a major difference in your long-term satisfaction.
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**Summary of this article**
- Rhinoplasty is not just about shaving cartilage—it's about creating a strong **"support structure (foundation)."**
- Precise design that anticipates cartilage absorption (approximately 7–8%) and plans for years ahead is essential.
- The optimal cartilage material is selected based on each patient's condition, and the combination of the right material for the right application is key.
- By carefully repairing the invisible "ligaments," while individual results vary, long-term stability and beautiful outcomes are expected.
If you are interested in your nose structure or the optimal approach for your case, please feel free to consult with us first. At Zetith Beauty Clinic, we provide evidence-based counseling.
**References**
- Block L, Pfaff M, Harris A, et al. The Crooked Nose: A Practical Guide to Successful Management. Plastic & Reconstructive Surgery. 2022 (DOI)
- Boustany A, Grover R, Alnaeem H, et al. Cosmetic Rhinoplasty. Plastic & Reconstructive Surgery. 2023 (DOI)
- Kim J, Song J, Park S, et al. Tip Extension Suture. Plastic and Reconstructive Surgery. 2014 (DOI)
- Lee Y, Choi Y, Bae C, et al. Crushed Septal Cartilage-Covered Diced Cartilage Glue (CCDG) Graft: A Hybrid Technique of Crushed Septal Cartilage. Aesthetic Plastic Surgery. 2022 (DOI)
- Daniel R, Palhazi P, Gerbault O, et al. Rhinoplasty: The Lateral Crura–Alar Ring. Aesthetic Surgery Journal. 2014 (DOI)
- Çakır B, Genç B, Finocchi V, et al. My Approach to Preservation Rhinoplasty. Facial Plastic Surgery Clinics of North America. 2023 (DOI)
- Yaremchuk M, Kachare S. Invited Discussion on: Paranasal Augmentation Using Diced Costal Cartilage for Midface Concavity—A Retrospective Study of 68 Patients. Aesthetic Plastic Surgery. 2022 (DOI)
- Daniel R, Kosins A. Current Trends in Preservation Rhinoplasty. Aesthetic Surgery Journal Open Forum. 2020 (DOI)
**About the author of this article**
Tetsu AkiraPhysician
Board Director, Medical Corporation SUNSET — Zetith Beauty Clinic Ginza, Osaka, Fukuoka
Specializing in anatomically-based rhinoplasty with an annual case volume among the industry's highest. Known for surgical design emphasizing structural support and an approach pursuing long-term stability.