Surgical me­thods in rhinoplasty.

If every nose were operated on according to the same scheme, a great deal could be simplified — but that would not serve the best possible result. Because every nose is different: in its bony and cartilaginous structure, in the nature of the skin, in form and function and in the patient's wishes.

That is why we do not commit ourselves to one technique in advance. Our experienced team of surgeons has mastered every procedure in modern nasal surgery and decides for each operation individually which method — or which combination of methods — will most reliably bring you closer to your goal. That way the choice of method always stays what it should be: optimal for you.

We work a great deal with the modern nose-bridge-preserving technique, known as dorsal preservation, and with hybrid techniques — not exclusively with traditional structural septorhinoplasty. The natural nose bridge is preserved instead of being removed and rebuilt.

To understand what this means, it helps to look at what a hump actually is. The nose bridge consists of a bony and a cartilaginous part, which meet over the nasal septum like a roof. In the classical, structural approach this roof is taken down at its highest point. This creates an open surface which then has to be closed and rebuilt — the line of the nose bridge is thereafter a reconstructed line.

With the nose-bridge-preserving technique this roof remains untouched. The height is not reduced at the bridge itself but lower down: a precisely measured piece of material is removed from the nasal septum and, depending on the variant, from the area beneath the nasal root. The entire nose bridge is thereby lowered as a unit and retains the surface it grew with. The line you see afterwards is your own — simply set lower.

This has three advantages. The result looks particularly natural. It is stable in the long term. And the risk of later irregularities on the nose bridge is reduced — which counts above all with thin skin, because there even the smallest edge becomes visible. Certain deviations also recur less often.

And one point of context that matters to us: dorsal preservation is not generally superior. For many findings it is the gentler choice, but there are starting situations in which a structural reconstruction is the better solution — for instance when the nasal septum is severely deformed, when material is missing after previous operations, or when the nose bridge is to be raised rather than lowered. That is precisely why we do not commit ourselves to one technique but choose it according to the findings. In between lie the hybrid techniques. They concern the nasal bridge alone: part of the bridge is preserved while other structures are modified in a targeted way. That keeps the advantages of dorsal preservation while widening the range of cases it can be used for.

We stabilise the nasal tip with modern cartilage-supported techniques. This considerably reduces the risk of the tip dropping again over the years.

The background: the tip is carried exclusively by cartilage — by two paired alar cartilages that brace against each other, and by the front edge of the nasal septum, which holds it from below. If volume is taken away from this construction without replacing the mechanics, the tip loses its support. It can then migrate downwards over the years, the nose looks longer and the profile becomes curved again. The result that was right after one year is no longer right after ten.

Cartilage-supported means: we do not only shape the tip, we carry it. Several elements are available for this, which we use individually or in combination depending on the findings — a strut along the columella, an extension of the nasal septum towards the front, a reinforcement of the alar cartilages or a fine graft on the tip itself. All from the patient's own cartilage, all secured with very fine sutures.

This work takes operating time and cannot be seen from the outside. It is the reason why a nose should still look the same in ten or twenty years as it did in the first year.

Noses with thick skin, a broad bony base, a low bridge or a tip with little definition call for a strategy of their own. The classic reduction does not get there: the more volume is taken away, the less the framework carries the skin — and the tip does not become finer, it becomes shapeless.

The route is therefore a different one, building up rather than taking down. A stable cartilage framework carries the tip against the thick skin and gives it from within the definition that could not be worked out from the outside. Structural grafts of the body’s own cartilage support the columella, the septum and the alar cartilages; added to that is careful handling of the soft-tissue envelope itself, which with thick skin co-determines over months how fine the result finally looks.

To that end, Dr. Christoph Grill and DDr. Jessica Wittmann spent a fellowship in Brazil in 2026 working intensively with new and modern techniques of rhinoplasty — with a focus on thick skin and on ethnic nasal shapes. These techniques now feed into the work at the Kuzbari Centre.

The character of your nose is preserved in the process. An ethnic nasal shape is not a finding to be corrected but a part of your face: what is to change you settle in the initial consultation on the 3D simulation — and what is to stay, just as much.

The approach is not the method but the route to the method. It determines how much of the anatomy the surgeon sees and how directly it can be worked on — not what is ultimately done.

Closed. All approaches lie inside the nose, on the inner side of the nostrils. Nothing is visible from the outside. The structures are reached through these openings and partly brought outwards in order to work on them. With circumscribed corrections that can be planned well, this is an elegant route: the soft-tissue cover over the nasal tip is released less, the swelling is generally less pronounced and recovery is somewhat quicker. The price for this is a less direct view — the work is done in part by feel and experience.

Open. In addition to the internal approaches there is a fine incision across the columella. The skin of the nasal tip can thereby be lifted like a lid, and the entire framework lies under direct view. For everything that has to be built symmetrically and sutured precisely — cartilage-supported stabilisation of the tip, reconstruction of a collapsed nose bridge, straightening of a marked deviation, revision surgery on scarred tissue — this is the safer route. The scar on the columella lies in a natural shadow zone and is, as a rule, barely discernible once healed.

Neither of the two approaches is fundamentally better. We choose it according to what needs to be done in your nose — and before the operation we tell you which we have decided on and why.

Whenever the bony part of the nose has to be altered during a rhinoplasty, we work with a piezotome. This is an ultrasound instrument that cuts and smooths bone while leaving the soft tissue, the mucous membrane and the blood vessels untouched — classically this step is carried out with a chisel and a saw. For patients it means more precise work on the bone and, as a rule, fewer bruises and less swelling in the days that follow.

An honest classification matters to us: the piezotome is not a method of rhinoplasty in its own right and it does not automatically make a nasal operation better. It is a tool for one step of the procedure. What remains decisive is the planning and the experience of the surgeon. We use the piezotome as standard in every nasal operation; Univ.-Doz. Dr Rafic Kuzbari has been doing so for years.

The projectometer is a fine stainless-steel measuring instrument placed directly on the nose within the sterile field. It carries a millimetre scale, an adjustable arm and a protractor, and with them it records the two values that determine the profile of a nose: how far the nasal tip projects forward — the projection — and how high the bridge sits.

DDr. Jessica Wittmann works with it during her nasal operations. Before the first step she takes the baseline measurement. After every further step — after the bridge has been lowered, after a support has been placed at the tip — she measures again and compares the figure with the plan drawn up during the initial consultation on the 3D simulation. Whether the bridge has been reduced by the planned amount and the tip raised accordingly is therefore settled in theatre as a measured value.

The classification matters to us: the projectometer makes no decisions. Planning and experience remain the surgeon’s achievement. The instrument checks them — and makes it possible to follow whether what happens in theatre matches what you saw on screen beforehand.

Terms appear in findings and operation reports that are seldom explained. The most important ones are set out here in plain words:

Septoplasty. The straightening of the nasal septum. It improves breathing and frequently supplies at the same time the cartilage that is needed elsewhere in the nose.

Osteotomy. A precise cut in the nasal bone which makes it possible to narrow or straighten the bony base. It is exactly this step that we carry out with the piezotome — the ultrasound instrument that works on bone without injuring soft tissue, mucous membrane and vessels.

Spreader grafts. Narrow strips of cartilage placed between the nasal septum and the upper lateral cartilages. They hold the internal nasal valve open — the narrowest point of the entire airway — and at the same time stabilise the line of the middle third of the nose.

Strut at the columella. A strip of cartilage anchored upright in the columella which carries the nasal tip from below. One of the most effective measures against a late dropping of the tip.

Extension of the nasal septum towards the front. A cartilage element placed on the front edge of the nasal septum which determines how far and at what angle the tip sits. It allows a drooping tip to be lifted without shortening it.

Suture techniques at the tip. Fine sutures that realign the alar cartilages in relation to one another and thereby narrow, define or lift the tip — without removing cartilage. Shaping instead of removing: this is gentler on the tissue and more stable in the long term.

Graft on the nasal tip. A thin disc of cartilage that gives the tip projection and definition. Often necessary with thick skin, because the skin otherwise swallows every piece of fine work beneath it.

Turbinoplasty. The careful reduction of enlarged turbinates. They remain functional — they are still to warm, humidify and clean the air we breathe — but gain space for the airflow.

Narrowing of the nostrils. The adjustment of the alar base through very small incisions in the natural fold. Frequently the final refinement, when the nose appears optically wider as a result of lifting the tip.

A rhinoplasty with us takes one to four hours. This range is intentional: we operate in our own operating theatres and therefore without time pressure — for as long as it takes until every detail is right. How long a procedure takes is decided by the findings, not by the schedule.

The choice of method has a direct effect on the duration. A limited correction via the closed approach lies at the lower end of the range. A cartilage-supported stabilisation of the tip with several grafts, a straightening with spreader grafts or a revision rhinoplasty with cartilage harvested from the rib area lies at the upper end. The more demanding technique is not the more expensive version of the same thing — it is the technique that these particular findings require.

An initial consultation with three-dimensional simulation, a technique that suits your nose, and an operating time that follows the findings — this effort is the reason why rhinoplasty with us has its price. It is also the reason why the result is meant to hold: for a lifetime, not for a few years.