Answer:
A standardized operative sequence is almost impossible to provide, as it must reflect the patient’s problems, the surgeon’s preferences, and the operative approach that has been selected. For example, a closed approach using an intracartilaginous incision will create definitive tip changes prior to dorsal modification, whereas in the closed/open approach the dorsum is corrected first and the tip last. However, these operative plans contain certain similar components, such as incremental dorsal reduction and alar base modification. Therefore, each of the operative approaches will be discussed in detail.
Open Approach:
incision, flap elevation, cephalic crura excision, extramucosal tunnels, dorsal modification, caudal septum modification, septoplasty, osteotomy, graft preparation, dorsum, spreader grafts, tip graft sutures, closure, alar base modification.
Closed Approaches:
transcartilaginous incision, skin elevation, rasp bony hump, cartilage or dorsum, radix reduction, caudal septum, septoplasty, infracartilaginous incision, alar cartilage delivery, excision alar cart, osteotomy, grafts, closure alar base modification.
intracartilaginous incision, alar cartilage resection, bony dorsum, cartilage dorsum, transfixion incision, septoplasty, grafts, osteotomy, closure alar base modification.