Reduction Structured Rhinoplasty

Reduction structured rhinoplasty is a rhinoplasty technique that combines elements from two rhinoplasty philosophies: simple reductive rhinoplasty and structural rhinoplasty. The goal is to achieve decreased nasal size while supporting a life-long, lasting nasal shape by employing the use of structural grafts.Reducing nasal size without replacing disrupted nasal support structures has historically led to poor outcomes.Structural grafts include spreader grafts, onlay tip grafts, columellar strut grafts, caudal septal extension grafts, and more. They are utilized to prevent internal nasal valve collapse, provide tip support, and prevent tip ptosis, retraction, or poor healing outcomes due to scarring. Different materials, including autologous cartilage and allogenic implants (i.e., high-density porous polyethylene) can be used as graft material. Preference for specific graft use differs from surgeon to surgeon, and continuous debate exists surrounding which grafts provide the most optimal results.This study outlines Romo III's tenured approach to reduction structured rhinoplasty and discusses various trends and debates in grafts that are currently utilized.