Comprehensive Structural Rhinoplasty

Full structural rhinoplasty is an open technique that completely reconstructs the nasal framework: extending the septum, rebuilding the columellar strut, and reshaping the nasal tip using autologous cartilage (septal, ear, or rib), which can be combined with an implant on the bridge. It is ideal for short and upturned noses, bulbous tips, thick skin, deviated noses, and revision rhinoplasty. The procedure takes 2–3 hours, with swelling lasting 2–3 weeks, and the final shape stabilizing at 12 months.

Medically reviewed by BS.Ths.CKII Nguyễn Xuân Vũ — BonBoz Clinic

Why is it called "structural"?

Instead of merely placing an implant over the existing framework, the surgeon performs an open rhinoplasty to evaluate each anatomical component (septum, alar cartilages, and columella) and rebuilds the framework from the ground up: extending the septum to lengthen the nose, placing a columellar strut to support the nasal tip, suturing and reshaping the tip cartilages, and placing cartilage tip grafts. This ensures the nasal shape is supported by a real structural foundation, rather than relying solely on an implant pressing against the skin.

Indications

Short, upturned noses with exposed nostrils; bulbous tips and thick skin requiring a sturdy framework for definition; weak columella or collapsed nasal tip; congenital or post-traumatic deviated nose; failed, contracted, or cartilage-deficient noses (revision rhinoplasty); or clients desiring an entirely autologous cartilage approach. For a simple low bridge with an otherwise well-defined tip, structural rhinoplasty may be overly invasive—cartilage-graft or semi-structural rhinoplasty is sufficient.

Where is autologous cartilage harvested?

Septal cartilage: firm, straight, harvested internally from the nose, with limited quantity. Ear (auricular) cartilage: soft, curved, ideal for tip-grafting. Costal (rib) cartilage: abundant, rigid, essential for complex and revision cases, requiring a sub-2–3 cm submammary/chest incision and carrying a risk of warping if not carved correctly. The surgeon selects and combines these sources based on the specific cartilage requirements of each case.

Recovery and Expectations

Noticeable swelling and bruising last 2–3 weeks, with splinting for 7–10 days; tip swelling resolves within 3–6 months, and the final result settles at 12 months. The outcomes are long-lasting because the framework is made of your own living tissue; however, skin thickness still sets the limit for refinement, and revision cases with scar tissue are inherently less predictable than primary rhinoplasty.

At BonBoz

MSc. Specialist Doctor II Nguyen Xuan Vu personally conducts the consultation, performs precise measurements, evaluates available cartilage and airway function, and may order a CT scan for revision cases. He thoroughly discusses the component-by-component plan, cartilage sources, risks, and limitations; personally performs the surgery, and manages long-term follow-ups (up to 12 months).

How is it performed?

General anesthesia or local anesthesia with sedation. Cartilage harvesting (septal cartilage via an endonasal approach; auricular cartilage via a postauricular incision; rib cartilage via a 2–3 cm inframammary incision if needed). Open rhinoplasty via transcolumellar and endonasal incisions to expose the framework; septal extension, columellar strut placement, alar cartilage reshaping, tip cartilage grafting, dorsal augmentation using cartilage or synthetic implants, and alar reduction if needed; closure, splinting. 2–3 hours.

Before the procedure

Complete pre-anesthesia examination and testing (blood work, coagulation profile, biochemistry, ECG, and chest X-ray if rib cartilage is harvested); discontinue medications affecting blood coagulation 1 week prior as directed; refrain from smoking 4 weeks before and after the procedure; fast for 6–8 hours; disclose underlying medical conditions, previous rhinoplasty history, allergies, and keloid tendencies; undergo a nasal CT scan for revision cases as indicated.

After the procedure

Splint worn for 7–10 days; visible swelling and bruising for 2–3 weeks; suture removal on day 7; take prescribed medications; apply cold compresses for the first 48 hours; sleep on your back with your head elevated for 4 weeks; avoid eyeglasses and any nasal trauma for 8 weeks; do not blow your nose forcefully for 3 weeks; properly care for the rib cartilage donor site (if applicable); follow-up appointments on days 2, 7, 30, 90, 180, and 365; nasal tip swelling subsides within 3–6 months, with the final aesthetic result achieved at 12 months.

Possible risks — your doctor explains them before treatment

Swelling and bruising for 2–3 weeks; numbness at the nasal tip for several months
Infection, hematoma (rare, manageable with early intervention)
Costal cartilage warping over time if not handled properly
Deviation or asymmetry requiring minor revision after 12 months (low rate)
Scars along the columella and rib donor site (fade over time; keloids in predisposed individuals)
Chest pain for a few days; pleural injury during rib cartilage harvesting is rare
Temporary nasal congestion; septal perforation is rare
Revision rhinoplasty outcomes are less predictable than primary procedures

Who should NOT have this?

A low nasal bridge with a well-defined nasal tip (cartilage-grafted or semi-structural rhinoplasty is sufficient — full structural rhinoplasty is unnecessary)
Uncontrolled underlying medical conditions; coagulopathy; not medically cleared for general anesthesia
Currently pregnant or breastfeeding
Active facial infection or ongoing inflammation following a previous surgery (must wait 6–12 months)
Unrealistic expectations, such as wanting someone else's nose shape or expecting a sharply refined tip on very thick skin
Under 18 years of age; unable to quit smoking

BS.Ths.CKII Nguyễn Xuân Vũ

Department of Plastic and Aesthetic Surgery

Master of Medicine and Pharmacy — Specialist Level I Surgical Resident, Hue University of Medicine and Pharmacy (2014–2017)
Specialist Level II Doctor in Plastic and Aesthetic Surgery
Specialist Level I in Plastic and Aesthetic Surgery — Pham Ngoc Thach University of Medicine; Specialist Level II in Healthcare Management — University of Public Health
Specialty Certificate in Orthopedics and Traumatology and Certificate in Plastic and Aesthetic Surgery (2017)
Medical Practice License No.: 007827/ĐL-CCHN — Issued by Dak Lak Province Department of Health on 04/12/2017
Over 15 years of experience, more than 20,000 surgeries
Specialist Level II Doctor in Plastic and Aesthetic Surgery at Ho Chi Minh City Hospital of Dermatology (2020–present); previously Lead surgeon for major and minor procedures at Sao Han Hospital (2018–2020)
Member of international humanitarian organizations Operation Smile and ReSurge International — performing pro bono reconstructive surgeries for patients with congenital deformities, cleft lip, cleft palate, and ptosis (2022–present)
Affiliated with Alcon Pharmaceutical (USA)
Member of the Korean College of Cosmetic Surgery (KCCS)
Medical Director of BonBoz Clinic

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Frequently asked questions

How does full structural rhinoplasty differ from semi-structural rhinoplasty?

Full structural rhinoplasty rebuilds the entire framework using autologous cartilage, uses an open approach, and addresses the septum; semi-structural rhinoplasty preserves the underlying framework, only reconstructing the columella and the tip.

Is rib cartilage harvesting mandatory?

No. Rib cartilage is only harvested for cases requiring a large amount of cartilage (revision rhinoplasty, significant lengthening); other cases utilize septal and ear cartilage.

How are the pain and scarring from rib cartilage harvesting?

The 2–3 cm incision is located under the breast/inframammary fold; it is sore for a few days and fades over time; hypertrophic scarring is rare unless the patient is predisposed.

How long does the swelling last?

Noticeable swelling and bruising last 2–3 weeks; the nasal tip refines within 3–6 months; the final shape settles at 12 months.

Is general anesthesia required?

General anesthesia or local anesthesia with intravenous sedation is usually required because the surgery lasts 2–3 hours; comprehensive pre-anesthesia testing is mandatory.

Can thick-skinned noses achieve a slim, refined look?

It becomes significantly neater and more projected thanks to the strong framework, but thick skin still limits the level of refinement — the surgeon will explain this clearly beforehand.

Does rib cartilage warp?

It has a tendency to warp if not carved properly; an experienced surgeon handles it to minimize this risk. Warping typically becomes apparent after a few months.

Why is the cost higher?

It involves a longer surgical time, anesthesia, multiple cartilage harvest sites, complex techniques, and a longer follow-up period.

How long do the results last?

Because the framework is made of your own living tissue, the results are long-lasting; natural skin aging will still occur.

Who performs the surgery at BonBoz?

Dr. Nguyen Xuan Vu, MSc, Specialist Level II, Medical Director specializing in Surgery and Plastic Surgery, directly performs the entire procedure from start to finish.