Can Dr. Toriumi work with big and wide noses?

Some patients just cannot have a small nose based on their anatomy, skin thickness, or effects from previous surgery. In the ideal setting all patients would have whatever sized nose that they want. Unfortunately, this is not reality.

Patients who have thinner, pliable skin and noses that are larger are more likely to tolerate a significant downsizing of their nose. In these patients, their thinner skin will tend to shrink over time to accommodate the reduction in their nasal cartilage and bone structure. This shrinkage may take many months or even years. Therefore, these patients will likely be unhappy early on, before their swelling subsides and the skin shrinks to accommodate the new nasal structure. If the nose is made too small, the skin may never completely contract and may leave a deformity.

For most rhinoplasty patients Dean Toriumi will perform digital imaging during the initial consultation to demonstrate what he feels is a realistic outcome. Dean will try to make the nose smaller if he feels the skin will accommodate such a change. This requires a great deal of judgment, and Toriumi prefers to make a nice improvement by decreasing the size of ones nose by a safe degree as opposed to making it too small and having the skin droop.

Illustrative patient cases:

The patient shown below had a prominent overprojected asymmetric nasal tip and wide dorsum. In order to create better balance in her nose Dean Toriumi decreased her nasal tip projection. Her preoperative computer imaging showed a larger nose than what was achieved at the time of surgery. Because her skin was relatively thin and redraped well he was able to make her nose smaller than the preoperative computer imaging. Toriumi also narrowed her bridge and straightened her asymmetric nasal tip.

In following my patients over many years, I have found that the middle vault region (mid portion) of the nose tends to narrow dramatically over time. Patients on whom I operated tended to develop narrowing of the middle vault region over many years. In patients with thinner skin and shorter nasal bones, their middle vault region tended to narrow too much and become pinched years after surgery.

The patient shown below was operated on 9 years ago. She had a bulbous tip and dorsal hump. I performed a dorsal hump reduction and placed spreader grafts. Despite the spreader grafts her middle nasal vault gradually collapsed over many years. The collapse occurred because the patient has thin skin, short nasal bones and long upper lateral cartilages. If this patient had thick skin her deformity would be less prominent. This patient needed thicker spreader grafts or a slight degree of overcorrection of her middle nasal vault to prevent this collapse. By following my patients long term I am able to see these problems and make adjustments in my technique.

Dean Toriumi Reviews: Severely deviated nose with nasal airway obstruction

Testimonial #24

This patient presented with a severely deviated nose with nasal airway obstruction. She desired a straight nose and improved nasal function. The patient also has thin skin which makes the surgery more complicated and very difficult to create a straight nose.

My decision to go to Dr. Toriumi for my primary rhinoplasty was actually a very simple decision. I wanted the best possible outcome performed by the best possible team. I wanted to make certain this would be my first and last rhinoplasty because I was only going to have it done in the first place if it was done right the first time. 

Dr. Toriumi is world renowned for his perfectionism and for this surgery, I wanted nothing less. I was also very impressed with the care he takes in not only the appearance, but primarily the function of the airways and the technical correctness of his work and the well being of his patients. Dr. Toriumi also has an amazing staff that made me feel very comfortable throughout the process. My pre-op and post-op follow ups have been nothing short of pleasant with all of my questions answered. My surgery day was just as comfortable, and I was well taken care of by the nurses and Dr. Toriumi himself, who actually checked in on me hours after my surgery.

~ K.M.

Dean Toriumi Reviews: Straightening of nose and removal of dorsal hump

Testimonial #23

This patient presented requesting straightening of his nose and removal of his dorsal hump. He also had a deviated septum that caused nasal airway obstruction. He also had a complicated deformity of his nasal bones. Correction required straightening his nasal bones and his septum.

I have been a patient of Dr. Dean Toriumi for four years. I was extremely fortunate to have been referred to such a talented physician who is also a wonderful person. 

From the day that I met Dr. Toriumi at my initial consultation, I knew that he had the skill and competence to take on a case as challenging as mine and achieve outstanding results. My first impression was that he was intelligent, articulate, and an expert in his field. At the end of the day, I can say that Dr. Toriumi possessed all the qualities that I originally thought he had and that I received the best medical care available anywhere. I cannot imagine that there is anyone out there, more capable or qualified in his specialty. 

In my particular case, Dr. Toriumi performed extensive reconstruction of my nose. The surgery was a five hour procedure. My nose was broken in a construction accident and was a complex case. I was completely satisfied with the treatment plan that Dr. Toriumi formulated and the results he was able to achieve. Every aspect of the treatment plan was layed out well from start to finish, and every phase of the process was also communicated well. Dr. Toriumi was insightful, attentive to detail, and precise in everything he set out to accomplish. 

Equally phenomenal were the members of Dr. Toriumi’s office staff and work team. I found them to be a remarkable group of individuals; and just like Dr. Toriumi – exceptional in every way. They were friendly, professional, and even took the time to know the patients by name. It was very reassuring to be in such a supportive and caring environment. 

I cannot say enough about Dr. Toriumi or the outcome of my treatment. He has the incredible gift of being highly skilled and naturally talented. Dr. Toriumi exceeded my expectations in every way. My breathing problems are solved completely and with excellent cosmetic results. Over the course of the last four years, every treatment Dr. Toriumi has carried out has been completed with precision, perfection, and success. I am a patient that is 100 % satisfied and I credit Dr. Toriumi with enhancing and restoring the quality of my life. He has been a blessing to me.

~ A.A.

Dean Toriumi Reviews: A collapsed nose due to previous surgery and nasal trauma

Testimonial #22

This patient presented with a collapsed nose due to previous surgery and nasal trauma. She has severe nasal obstruction and a pinched middle nasal vault. Because of her previous surgery her septum was depleted and deviated. We used costal cartilage to reconstruct her nose and correct her nasal airway obstruction.

I read all the complaints and was in complete shock. I had a wonderful experience and I wish you could see my nose. My friends tell me I have taken years off my looks and my nose is straight and thin. I was referred to Dr. Toriumi by a friend and I have never been happier. I broke my nose for the third time and the damage was extensive. My ENT told me I would need another surgery and he said he could fix the inside but the damage was extensive and maybe I should see a plastic surgeon. I had already had one compromise surgery and wasn't sure I wanted to try again. Since Dr. T was recommended I decided to see him. He explained everything to me and spent over 6 hours in surgery trying to repair all the damage. He had to take part of a rib bone to rebuild the nose. I had the surgery done in October, 2007. I hadn't been able to breathe from my nose properly since I broke my nose the first time. Now, I can breathe and my nose is narrow and straight. It looks good and does work. I also had some bone buried in the back of head but it bothered me and I had the Dr. remove it. Dr. T has been nothing but nice and caring. He doesn't waste time in small chat but that's o.k. with me because I know he cares about me and my problems. He does have me come back every four months but that works because he had to correct some things that didn't show up right away. I had three bumps on my nose that he fixed with a needle shave in the office. 

As for his staff, I have never found a nicer group of people. Starting with Patty at the reception desk to Jan and Pat (nurse) they are friendly, always remember me, and want an update on how I am doing. I think they are one of the reasons I don't mind going back so often. I think anyone looking for a good caring doctor would be happy with Dr. T.

~ M.N.

Dean Toriumi: Cleft Lip and Reconstructive Surgery 2

Cleft Lip and Reconstructive Surgery: 2

The next patient underwent several previous surgeries to correct her nasal deformity leaving her with near complete blockage or stenosis of her right nostril. This was a very complex deformity, and her inability to breathe through her nose made simple activities very difficult. We performed a multiple stage operation to correct her deformity using rib cartilage and a large composite ear cartilage graft. In the first stage, Dean Toriumi placed the basic structure for her nose and corrected her nostrils to open her airway. In a second procedure, Dean Toriumi refined her nasal tip. She is now over a year out from surgery and has a nice improvement in her nasal appearance. More importantly she can breathe through her nose. 

Dean Toriumi: Cleft Lip and Reconstructive Surgery

Cleft Lip and Reconstructive Surgery

Patients who have a cleft lip frequently have an associated nasal deformity. These deformities can vary in their severity. This deformity can leave the patient with severe asymmetries of the nostrils and base of the nose. Most cleft lip patients undergo initial nasal surgery as an infant to help improve the nasal shape and function at the time of the correction of the lip and palate defects. Dean did not do this early stage of the correction. Instead, patients with cleft lip nasal deformities come to see me once they are in their teens or as adults seeking improvement in their appearance and nasal function. Dean Toriumi had used advanced techniques incorporating rib cartilage grafting to treat patients with cleft lip nasal deformities.

The combination of the rib grafting and specialized ear cartilage grafting allows me tremendous control for correcting deformities associated with the cleft lip nasal deformity. Dean Toriumi considers the nasal deformities in these patients to be similar to a severe secondary rhinoplasty deformity involving the nostrils and nasal base. He finds this type of surgery very satisfying, as the patients are very grateful for their correction and understand that perfection is not possible.

The patient shown below had several previous surgeries to correct her nose, leaving her with a residual asymmetry of her nostrils and nasal base. Dean used rib cartilage and ear cartilage composite grafts to improve her nasal appearance. She is very happy with her outcome despite some residual asymmetry of her nostrils. 

Dean Toriumi Reviews: Severely scarred nose and a poorly projected nasal tip

Testimonial #21

This patient presented with a severely scarred nose and a poorly projected nasal tip. Multiple prior surgeries left the patient with a wide nose, poorly defined nasal tip and severe under-projection. Correction required use of costal cartilage grafting and increased tip structure.

I had a rhinoplasty many years ago. It resulted in a small nose with airway blockage on the right side. The surgeon passed away a few months after my procedure and his surgical associate performed a number of corrections throughout the years, which resulted in a smaller nose, continued blockage and scar tissue. I gave up on the idea of ever having a decent looking nose that functioned normally. Dr. Toriumi performed nose surgery on two colleagues at work and the results were beautiful. I read about Dr. Toriumi's success with secondary rhinoplasty procedures in Chicago Magazine and decided to make an appointment for a consultation. During the consultation he told me he would get me to where I needed to be. I had surgery and for the first time in my life, I was able to breathe through both sides of my nose. I was so happy with the results that I decided to have a facelift and blepharoplasty the following year. It doesn't look as though I had surgery. My face and eyes look so natural. The scars healed so well, there is no evidence that was cut. Unfortunately, I had an accident while on vacation. I walked into a glass door and broke my nose. Dr. Toriumi performed nose surgery again. I had no available cartilage and so he used costal cartilage to lengthen my nose. The results are incredible. I can breathe perfectly and my nose is a work of art. I never thought I would have such a beautiful and well functioning nose. Dr. Toriumi is a master of his craft. He has always treated me with respect and listened to my concerns. His staff is friendly, professional and compassionate. I would give the entire experience an A+.

~ H.R.

Dean Toriumi Nasal Surgery

Nasal Surgery: Preserving Ethnic Contour

This patient had a crooked nose with a large dorsal hump. His dorsal hump was reduced and his radix augmented to provide a straighter profile. The patient had larger nostrils that were reduced to provide a more normal alar base. Some degree of ethnic contour was preserved in this patient as well. The photographs show his one-year postoperative outcome.

Dean Toriumi Reviews: Requesting repair of a septal perforation due to a laser procedure for nosebleeds

Testimonial #20

This patient came to the office requesting repair of a septal perforation due to a laser procedure for nosebleeds. Repair of the septal perforation required extensive internal work. Repair of the septal perforation was successful and his nasal airway breathing is much improved. We also made some conservative aesthetic changes.

"Outstanding doctor and operation. Dr. Toriumi was very generous with his time. I came to him with a perforated septum as a result of a laser procedure to stop nose bleeds. He repaired the perforation and while he was in there, also fixed a deviation and the result is that I am breathing well through my nose for the first time in my life. He was matter of fact about everything and made no promises, yet was honest and optimistic about what to expect. Everything turned out as he expected it would - outstanding. The fact that my nose looks great too is just a bonus."

~ J.S.