Toriumi Facial Plastics

Toriumi Facial Plastics Dr. Toriumi, M.D. is a board certified facial plastic and reconstructive surgeon and world renowned Dean Toriumi, M.D.

is a uniquely skilled, board certified facial plastic surgeon, highly sought-after and known worldwide for his expertise in rhinoplasty surgery. Dr. Toriumi and Toriumi Facial Plastics offer world-class care for a variety of facial plastic surgery procedures. You will experience the highest quality care provided by a surgeon and team with unmatched credentials and success, mastered over more than

30 years of attentive, patient-focused care. Learn more about Dr. Toriumi and our services. Call to arrange a free consultation with Dr. Toriumi. Your health – and peace of mind – will be in very good hands. Phone: 312-741-3202
Fax: 312-741-3123
Website: www.toriumifacialplastics.com
Email: [email protected]

(⚠️ 12-16) This 21-year-old female patient presented for revision rhinoplasty after undergoing multiple prior rhinoplast...
08/27/2026

(⚠️ 12-16) This 21-year-old female patient presented for revision rhinoplasty after undergoing multiple prior rhinoplasties for her unilateral cleft nose deformity. She wanted a more petite shorter nose with more definition. She had thicker skin and a lot of scarring. She was treated preoperatively and postoperatively with Dupilumab. Her reconstruction required two surgeries to get her to a point where we were satisfied with the outcome. Her reconstruction involved using her 8th rib with attached native perichondrium for a caudal septal replacement graft. She was treated intraoperatively with intradermal Kenalog injections and I also used deadspace sutures to control the thicker skin (Zholtikov). She has done very well postoperatively after the second surgery and recently got married.

Managing the unilateral cleft nasal deformity can be very complex due to the asymmetries of the nasal base and alae. Many of these patients have also undergone multiple prior surgeries on their nose which complicates the surgery. Using the patient’s own rib cartilage with the attached native perichondrium is important to long term success. Using the “no carve” technique minimizes the risk of cartilage warping and also improves vascularization of the cartilage grafts. In this case, I used her 8th rib with attached native perichondrium as her caudal septal replacement graft. Many of these complex deformities will require more than one surgery to get to the desired outcome.

Managing thick skin can be difficult and requires structural grafting and preoperative and postoperative skin care. The Dupilumab helps to control inflammation which is linked to postoperative swelling and scarring. Use of Dupilumab likely helped this patient with her postoperative recovery. I work with a dermatologist Dr. Rania Agha, MD FAAD at Summit Dermatology who administers the Dupilumab. Her second surgery was less than three months before her wedding and her nose looked great for her big event. These experiences are very gratifying for me as well and I feel blessed to be able to help patients in this way. 🙏🏼
All of these original techniques are demonstrated in my three-volume textbook, "Structure Rhinoplasty: Lessons Learned in Thirty Years," and in the new two-volume textbook, "Structure Preservation Rhinoplasty," both of which are available on the Marina Medical website. The artwork in this post is from the QMP book. The new "Structural Preservation Rhinoplasty" textbook is available on the QMP website. I also encourage you to join us in sunny South Florida for the fourth annual Marina Medical Preservation Rhinoplasty "The Course" that will be held December 11 to 13, 2026. The important Structural Preservation Rhinoplasty Meeting will be held in Istanbul, Turkey, November 19 to 21, 2026

(⚠️8-14) This 54-year-old patient presented after undergoing two prior rhinoplasties. She has very thick skin and had an...
08/20/2026

(⚠️8-14) This 54-year-old patient presented after undergoing two prior rhinoplasties. She has very thick skin and had an amorphous droopy tip with nasal obstruction.
She was treated preoperatively with Dupilumab (Dupixant) to manage her thick skin. Dupilumab blocks inflammation pathways and can dramatically improve postoperative healing after rhinoplasty. Her reconstruction required using her own rib cartilage (7th and 9th ribs). I placed a caudal septal replacement graft with native perichondrium (no carve technique) using her 9th rib and fixed it into a notch in the nasal spline. I placed a single midline tall spreader graft and fixed it to the caudal septal replacement graft. I then advanced the medial crura anteriorly to open the nasolabial angle and shorten her upper lip. I also placed lateral crural strut grafts with lateral crural replacement grafts and lateral crural extension grafts. I used platelet rich fibrin with diced fat for dorsal camouflage (Kovacevic) and deadspace sutures to close the deadspace (Zholtikov). At the end of the case, I injected triamcinolone acetonide (10 mg/ml) intradermally into the thick tip skin. Postoperatively she did postop hyperbaric oxygen treatments and an anti-inflammatory diet Chef Beau's Klean Kitchen for one month postop.
She is one-year postoperative and doing well with excellent nasal breathing and improved tip and nasal contour. Treatment with the Dupilumab pre and postoperatively contributed to her less inflammatory recovery after surgery. I treat these patients in conjunction with Rania Agha Dr. Rania Agha, MD FAAD who is a dermatologist. With thick skin it is imperative to provide good structure that can stretch the thicker skin envelope to create shape. Patients with thick skin cannot have small noses unless their skin envelope is small to start with.
Use of the 9th rib with the “no carve” technique allows excellent integration of the graft with low likelihood of resorption or warping. I will frequently use the 8th and 9th ribs for cartilage grafting using the “no carve” technique.
Our outcomes with rhinoplasty in thick skinned patients are much improved with the multimodality approach with Dupilumab, structural grafting, deadspace sutures, intraoperative triamcinolone injections, postoperative HBO and the anti-inflammatory diet. Use of Dupilumab for rhinoplasty in patients with thick skin has great potential and we will publish our data on our experience very soon.

All of these original techniques are demonstrated in my three-volume “Structure Rhinoplasty: Lessons Learned in Thirty Years” and the new two volume “Structural Preservation Rhinoplasty” textbook. The Structural Preservation Rhinoplasty textbook can be purchased on the QMP website. The Structure Rhinoplasty: Lessons Learned in Thirty Years series can be ordered at the Marina Medical Website. Time is running out to register for the Marina Medical Preservation Rhinoplasty “The Course” held December 11 to 13, 2026 in South Florida. This course features three fresh cadaver heads over three days to learn high strip, intermediate strip and low strip from the Masters of Preservation rhinoplasty. The Structural Preservation Rhinoplasty meeting in Istanbul, Turkey is November 19 to 21, 2026.

This 51-year-old patient presented after undergoing four prior rhinoplasties. She had an over reduced nasal dorsum with ...
08/15/2026

This 51-year-old patient presented after undergoing four prior rhinoplasties. She had an over reduced nasal dorsum with multiple dorsal irregularities due to prior diced cartilage and fascia graft. She had an underprojected nasal tip with alar retraction and nasal obstruction. Her reconstruction used her own rib cartilage and a single midline tall spreader graft with caudal septal extension graft and lateral crural replacement grafts with lateral crural strut grafts.
She had extensive scarring in her left nasal vestibule and required placement of a lateral crural extension graft and large composite graft.
She is five years postop and doing well with good dorsal alignment, projected tip and symmetrical alar margins. Her nasal function is very good as well. 👏🏼

Correction of alar retraction over the long term is one of the top three most difficult secondary rhinoplasty deformities to correct. Most surgeons use alar rim grafts. I do not believe alar rim grafts are as effective as lateral crural replacement grafts with lateral crural strut grafts and lateral crural extension grafts. Composite grafting is frequently needed as well. This takes much more time and is much more complex, but my long term follow up shows excellent longevity to the correction. My preference is to avoid placing grafts in the premarginal vestibular skin as this area of the tip does not normally house cartilage and is soft and pliable. By leaving this area undissected, there is a “buffer zone” caudal to all grafts that allows for better alignment of the alar margins and less thickening of the alar lobule.

This 56-year-old patient presented for revision rhinoplasty after undergoing four prior rhinoplasties. She originally co...
08/06/2026

This 56-year-old patient presented for revision rhinoplasty after undergoing four prior rhinoplasties. She originally contacted me years earlier but had her latest surgery elsewhere. She presented with a contracted, short, and deviated nose with an asymmetrical, over rotated nasal tip. She also had very thin, contracted skin. She had severe nasal obstruction due to nasal valve collapse and nasal vestibular stenosis. Her nasal skin envelope was very tight, and this can limit the degree of correction that is possible.
In order to loosen the skin envelope, I asked the patient to perform nasal stretching exercises for one minute twenty times a day in four different locations (tip, alar margins, and columella). This is shown in the video. The patient did this for over six months prior to surgery. The stretching helps tremendously as it decreases the amount of tension on the nasal skin when performing the reconstruction. This decreases the likelihood of skin necrosis or other related problems. At the time of surgery, I used her 7th and 8th ribs, placing a single midline tall spreader graft with her 8th rib. I also placed a caudal septal extension graft and lateral crural strut grafts with lateral crural replacement grafts. I then placed platelet rich fibrin with fat (PRF fat) on her nasal dorsum which was key to her smooth dorsum. This technique was described by Milos Kovacevic. She has done well both aesthetically and functionally and is two years postoperative.

Patients with thin contracted skin introduce a very difficult problem for the patient and surgeon. The patient wanted her nose lengthened, and her tip turned down. This can be done structurally but if the skin does not accommodate the larger structure, this can create tension on the closure and potential complications. I have patients perform nasal stretching exercises, use structural grafting with the patient’s own rib and also add modalities such as hyperbaric oxygen treatments, Silastic healing chamber and fat to the nose. All of these modalities are critical to a successful outcome. Healing with thin skin can also be very problematic as the skin can contract creating deformity.
I believe achieving a good aesthetic and functional rhinoplasty outcome in the long-term is the most difficult task facing the rhinoplasty surgeon. Long term is defined as the rest of the patient's life. This requires a much different approach that is not the easiest but the most structurally stable, frequently sacrificing the short-term outcome to get the best long-term outcome.

All of these original techniques are demonstrated in my three-volume textbook, "Structure Rhinoplasty: Lessons Learned in Thirty Years," and in the new two-volume textbook, "Structure Preservation Rhinoplasty," both of which are available on the Marina Medical website. The artwork in this post is from the QMP book. The new "Structural Preservation Rhinoplasty" textbook is available on the QMP website. I also encourage you to join us in sunny South Florida for the fourth annual Marina Medical Preservation Rhinoplasty "The Course" that will be held December 11 to 13, 2026. The important Structural Preservation Rhinoplasty Meeting will be held in Istanbul, Turkey, November 19 to 21, 2026

This 36-year-old patient presented after undergoing prior rhinoplasty. She wanted a narrower nose with improved lateral ...
07/31/2026

This 36-year-old patient presented after undergoing prior rhinoplasty. She wanted a narrower nose with improved lateral view tip contours. I performed her revision surgery using her own rib cartilage and also placing a caudal septal extension graft with lateral crural strut grafts and lateral crural extension grafts. I also used tall spreader grafts to narrow her dorsum. She has done well and is almost two years postop and is doing well with excellent nasal function. 👏🏼

I have been adding intraoperative photos to my IG posts but was told by patients that those images cannot be seen or are marked as “sensitive.” Therefore, I am not including intraoperative photos in this post. It is unfortunate as my intent of these posts is to help other surgeons improve their rhinoplasty techniques. I have included an illustration to help illustrate lateral crural replacement grafts.

All of these original techniques are demonstrated in my three-volume textbook, “Structure Rhinoplasty: Lessons Learned in Thirty Years,” and in the new two-volume textbook, “Structure Preservation Rhinoplasty,” both of which are available on the Marina Medical website. The new “Structural Preservation Rhinoplasty” textbook is available on the Quality Medical Publishing website. I also encourage you to join us in sunny South Florida for the fourth annual Marina Medical Preservation Rhinoplasty “The Course” that will be held December 11 to 13, 2026. The important Structural Structure and Preservation Rhinoplasty Conference Meeting will be held in Istanbul, Turkey, November 19 to 21, 2026

BANGKOK 2026 🐟 I was very happy to participate in the Nose by FATS World Congress in Bangkok, Thailand last week. Eddie ...
07/24/2026

BANGKOK 2026 🐟 I was very happy to participate in the Nose by FATS World Congress in Bangkok, Thailand last week. Eddie Liew and Docteur SABAN organized the meeting, and I was pleased to be part of the faculty. I enjoyed working with the international faculty including Yves Saban, Dr. Abdülkadir Göksel, Yong Ju Jang,MD as well as many local faculty.
The meeting was well organized and well attended. I had keynote presentations on “Asian Augmentation Rhinoplasty Using Preservation and Structure,” Revision Rhinoplasty in the Asian Patient,” and “Management of the Contracted Nose In the Asian patient.” 👃🏼 I also participated in a cadaver lab and performed a live cadaver Asian augmentation rhinoplasty using a push up technique with a subdorsal cantilever graft. I had very good material and I was able to demonstrate the technique to the lab participants. The meeting went very well and the participants were great.

I also enjoyed the Gala Cruise on the Chao Phraya River at the end of the meeting, spending time with participants and good friends. Eddies staff were fantastic and very helpful.

I spent some time seeing Bangkok and seeing some of the sites. I really enjoyed my time in Bangkok with Yves and Sylvie Saban, Elena and Goksel and Eddie Liew. I was able to tour the Grand Palace, Phra Kakhon, beautiful temples, The Reclining Buddha, the Mae Klong Railway market (train proceeds right through the middle of the market) and the Damnoen Saduak Floating Market. The Thai food was incredible with many spicy dishes and delicious fruits. I also had a relaxing massage at the famous Mandarin Oriental . I had an unbelievable meal at the Mandarin Oriental at Lord Jim’s restaurant. The experience in Bangkok was very memorable with unbelievable sites and experiences. Thank you, Eddie and Yves, for such a memorable experience! 🇹🇭

(⚠️6-16) This 52-year-old patient came for revision rhinoplasty after undergoing two prior rhinoplasties. She had very t...
07/17/2026

(⚠️6-16) This 52-year-old patient came for revision rhinoplasty after undergoing two prior rhinoplasties. She had very thick skin and on exam had very little structure in her nose. Her reconstruction required using her own rib despite being heavily calcified. In fact, I had to use the piezotome to perform the rib harvest and to carve the rib. The photographs show a very brown color to the rib indicating dense calcification. I fashioned a caudal septal replacement graft and single midline tall spreader graft and left as much native perichondrium on the grafts as possible to protect the grafts. This is important to maximize vascularization of the grafts. I also placed lateral crural replacement grafts and lateral crural strut grafts. She is two years postoperative and doing well both aesthetically and functionally.

Patients with thick skin need structure in their nose to create shape. It seems counterintuitive as you would think a smaller structure means a smaller nose. On the contrary, with thicker skin we need to make a bigger nose structurally to expand the skin envelope to create shape. I tell patients I have to make your nose larger on the profile to improve the frontal view. As the structure projects into the thick skin, it can stretch and expand the skin envelope to improve tip definition.

Management of the thick-skinned rhinoplasty patient requires a multifaceted approach. Patients also get intraoperative and postoperative steroid injections, dead space sutures (Zholtikov), postop hyperbaric oxygen treatments, taping, and at least one month of a strict anti-inflammatory diet. We have exciting new modalities that will be published soon. 👏🏼 🥦

All of these original methods are demonstrated in my three-volume textbook, "Structure Rhinoplasty: Lessons Learned in Thirty Years," and in the new two-volume textbook, "Structure Preservation Rhinoplasty," both of which are available on the Marina Medical website. The new "Structural Preservation Rhinoplasty" textbook is available on the QMP website. I also encourage you to join us in sunny South Florida for the fourth annual Marina Medical Preservation Rhinoplasty "The Course" that will be held December 11 to 13, 2026. The important Structural Preservation Rhinoplasty Meeting will be held in Istanbul, Turkey, November 19 to 21, 2026

This 32-year-old patient presented after undergoing two prior rhinoplasties. She had an over reduced nose with alar retr...
07/10/2026

This 32-year-old patient presented after undergoing two prior rhinoplasties. She had an over reduced nose with alar retraction. I used her own rib cartilage with caudal septal extension graft, lateral crural replacement grafts, and lateral crural strut grafts. I also used lateral crural extension grafts to maximize correction and symmetry of her alar margins. The lateral crural extension grafts are thin extensions off of the lateral crural strut grafts that precisely set the position of the alar margins. She had very thin skin, so I also used platelet rich fibrin with her fat for dorsal camouflage (Kovacevic). She is 16 months postoperative and has done very well with excellent nasal function and correction of her alar retraction and nasal deformity.

Alar retraction occurs primarily after over reductive rhinoplasty and worsens over time as scar contracture occurs. Correction is difficult and requires the patient’s own rib cartilage to provide a long-term outcome. Of even greater difficulty is creating symmetry of the alar margins. I have a technique that is very effective (lateral crural strut grafts with lateral crural extension grafts) for correcting alar retraction and is time tested as I have used it for over 35 years. It requires strong, large rib cartilage grafts and possible composite grafting. The problem with these grafts is that they can cause bumps on the side of the nose that can persist for over a year. My intent is to correct the alar retraction and provide a long-term aesthetic and functional outcome. If needed, the grafts can be trimmed in a minor revision procedure that can frequently be performed in the office. However, if you fail correcting alar retraction, reconstruction/correction requires a new rib harvest and another major operation. I believe this is the best approach for correcting alar retraction.

I recently published a paper entitled, “Use of Lateral Crural Strut Grafts for Correction of Alar Retraction” in This paper describes how I correct alar retraction in secondary rhinoplasty. I have a series of papers coming out in Facial Plastic Surgery and Aesthetic Medicine that describe my nasal tip techniques and my rib grafting techniques.

All of these original methods are demonstrated in my three-volume textbook, "Structure Rhinoplasty: Lessons Learned in Thirty Years," and in the new two-volume textbook, "Structure Preservation Rhinoplasty," both of which are available on the Marina Medical website. The new "Structural Preservation Rhinoplasty" textbook is available on the QMP website. I also encourage you to join us in sunny South Florida for the fourth annual Marina Medical Preservation Rhinoplasty "The Course" that will be held December 11 to 13, 2026. The important Structural Preservation Rhinoplasty Meeting will be held in Istanbul, Turkey, November 19 to 21, 2026.

I am honored to be able to present three keynote presentations at the World Meeting of in Facial Plastic Surgery jointly...
07/03/2026

I am honored to be able to present three keynote presentations at the World Meeting of in Facial Plastic Surgery jointly organized by the European Academy of Facial Plastic Surgery and the International Federation of Facial Plastic Surgery Societies in Lisbon, Portugal. 🇵🇹
The co-chairs of the meeting are and .dariobertossi
I was able to speak on Preservation rhinoplasty, Complex Nasal Deformities, and Ethnic Rhinoplasty. They have done a fantastic job with the program featuring rhinoplasty, aging face surgery, and all other forms of facial plastic and reconstructive surgery. Lisbon is a beautiful city and is a perfect venue for this important meeting 👨🏻‍⚕️

(⚠️7-16) This 26-year-old patient presented after undergoing multiple prior operations to correct a unilateral cleft nas...
06/25/2026

(⚠️7-16) This 26-year-old patient presented after undergoing multiple prior operations to correct a unilateral cleft nasal deformity. She also had a ala that was never corrected. She had a MedPor implant placed in her nose as well. Reconstruction required removing the MedPor implant and replacing it with her own rib cartilage. She underwent placement of a caudal septal replacement graft, lateral crural replacement grafts, lateral crural strut grafts, left lateral crural extension graft, and composite grafting to the left ala. A large composite graft was used to reconstruct the nasal vestibular stenosis and also to correct the notched alar margin. I injected nanofat around the composite graft to maximize composite graft survival. A very unique type of composite graft was placed in the notch at the left alar margin to correct the notch. Notched ala are very difficult to correct. This patient is doing well almost two years postoperatively after her corrective surgery, with improved tip symmetry and correction of her nasal obstruction.

Congenital defects can be very difficult to correct due to their multi-tissue layer composition. The alar notch involved the skin, subcutaneous tissues, and the internal vestibular lining requiring a multilevel correction (skin, mucosal lining, and structure). Composite grafting is frequently required in these cases, and this is why I avoid using ear grafts for structural grafting, preserving it for composite grafting if needed. I use the patient’s own costal cartilage for the structural grafting of the nose.

In many of these complex cases, there are imperfections that are due in part to the complexity of these operations. It is important not to overlook the complexity of the deformity and what was required to just get the patient back to normal. It is more sensible to look at the overall improvement in the patient’s outcome and not just focus on the imperfections. For full disclosure I always show the frontal, lateral, oblique and basal views to in part demonstrate that perfection is not possible. My objective is to educate surgeons and patients on what is possible with such complex deformities.

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