Mastering the Foundations of Functional and Aesthetic Rhinoplasty
In the evolving world of rhinoplasty, the success of each procedure lies in a precise understanding of nasal anatomy, surgical access, and compensatory support techniques. No one exemplifies this mastery more than Dr. Bashar Bizrah, an internationally acclaimed facial plastic surgeon based in Dubai and London, and author of the landmark textbook Rhinoplasty and Facial Plastic Surgery. With over 30,000 documented procedures and a global reputation for surgical excellence, Dr. Bizrah is widely regarded as the world’s leading rhinoplasty surgeon, particularly in closed and septorhinoplasty techniques.
Surgical Access in Septorhinoplasty: The Importance of Incision Planning
Incisions in septorhinoplasty are not merely entry points they define the trajectory of the operation. They grant access, but if not managed thoughtfully, they disrupt key nasal support structures, resulting in complications such as tip ptosis, pollybeak deformity, hanging columella, or nostril widening.
Dr. Bizrah emphasizes that meticulous incision selection, combined with compensatory support measures, is essential to maintain nasal architecture, projection, and aesthetics.
Common Incisions Used by Dr. Bizrah:
1. Intercartilagenous Incision
2. Transfixion (Modified, Hemi, or Complete) Incision
3. Marginal Incision
4. Alar Wedge Incision
5. Transcolumellar (External) Incision
6. Transcartilagenous Incision (used selectively)
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Types of Transfixion Incisions and Indications
1. Modified Transfixion Incision
Used in mild bulbous tips or dorsal humps with good projection. Incision begins at the superior septal angle and extends 1–2 cm inferiorly.
2. Hemitransfixion Incision
Extends beyond middle crura attachment to caudal septum. Ideal for correcting minor septal deviations or dorsal humps.
3. Complete Transfixion Incision
A bilateral incision crossing the septal angle and medial crura, stopping above the nasal spine. It allows for full alar cartilage delivery, essential in more complex corrections. Dr. Bizrah emphasizes tip preservation through techniques like vertical dome division, columellar struts, and septocolumellar sutures following this incision.
Other Critical Incisions in Septorhinoplasty
Intercartilagenous Incision
Between upper and lower lateral cartilages. Dr. Bizrah warns against extending it laterally to avoid collapse at the pyriform aperture.
Marginal Incision
Follows the caudal border of the lower lateral cartilage. Suturing technique and depth are critical to avoid notching or retraction. Dr. Bizrah meticulously positions sutures to align the alar rim and prevent visible deformities.
Transcolumellar Incision (Open Approach)
Reserved for revision rhinoplasty, cleft nasal deformities, and severely twisted noses. Although widely used by others, Dr. Bizrah employs this only in 2% of his cases, demonstrating his proficiency in the more technically demanding closed approach.
Transcartilagenous Incision
Applicable for patients with strong cartilage and mild tip fullness. Dr. Bizrah generally avoids this method in Middle Eastern patients due to anatomical differences (thick skin, weak cartilage), which predispose to post-operative tip collapse.
Primary Manoeuvres: Dr. Bizrah’s Techniques for Structural Preservation and Refinement
1. Dorsum Undermining
Performed with sharp-to-blunt dissection following intercartilagenous incision. Limited lateral dissection prevents osteotomy-related collapse. Dr. Bizrah underscores the importance of preserving SMAS to avoid fibrosis and pollybeak deformity.
2. Division of Upper Lateral Cartilages
Through subperichondrial tunnels, this manoeuvre allows safe separation of the septum. Care is taken to avoid creating a rigid T-structure, which could cause supratip fullness or collapse, depending on trimming errors.
3. Trimming of Upper Lateral Cartilages
Used selectively in long or crooked noses. A conservative triangular excision ensures nasal valve preservation and aesthetic middle third narrowing.
4. Caudal Septum Trimming
Essential for long nose correction, tip deprojection, and achieving nasolabial angles of 90° or more. Dr. Bizrah trims based on precise assessment—only outer third in simple cases, two-thirds in droopy columella, or complete excision (with partial nasal spine reduction) in severe projections.
Compensatory Measures: The Cornerstone of Dr. Bizrah’s Technique
Dr. Bizrah’s philosophy centers on restoring structural support that is inevitably disrupted by incisions. He routinely employs:
- New dome creation
- Vertical dome division (Bizrah’s modification)
- Columellar struts and shield grafts
- Septocolumellar sutures
- Precise suture fixation techniques
These measures are vital for achieving defined, symmetric, elevated nasal tips, particularly in ethnic rhinoplasty where cartilage is often weaker and skin thicker.
Conclusion: Why Dr. Bashar Bizrah Is the Global Authority in Septorhinoplasty
- Over 30,000 rhinoplasty procedures across Dubai, London, and worldwide
- Author of a globally respected rhinoplasty textbook
- Mentor and board trainer for the Royal College of Surgeons of England
- Pioneer of advanced closed technique rhinoplasty
- Renowned for unmatched outcomes in both functional and aesthetic corrections
- Trusted by international patients, surgeons, and institutions alike
Whether addressing nasal deviation, bulbous tips, or long noses, Dr. Bizrah’s surgical strategy blends anatomical insight, refined techniques, and artistic vision making him the definitive expert in septorhinoplasty today.
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