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]

(⚠️ 6-16) This 50-year-old male patient presented after undergoing four prior rhinoplasties. The patient suffered an inf...
06/12/2026

(⚠️ 6-16) This 50-year-old male patient presented after undergoing four prior rhinoplasties. The patient suffered an infection after a surgery using donor material. He then underwent a melolabial cheek flap by another surgeon that failed leaving the patient with a very complex situation with necrosis of his columella. He also had a very large septal defect due to a failed attempt at closure of a septal perforation. With no septum and no columella, the only option for reconstruction was a melolabial flap.

His left cheek was already used in the failed melolabial flap in his prior surgery. Reconstruction involved using a right melolabial flap with an “extended soft tissue coverage” subcutaneous soft tissue extension. In this flap, extra subcutaneous tissue is harvested with the flap and is used to cover the opposite side of the grafts. I used his 8th and 9th ribs with all of the perichondrium attached for a single midline tall spreader graft and caudal septal replacement graft.

The undersurface of the single midline tall spreader graft had minimal coverage but healed and mucosalized due to the presence of the perichondrium and also use of a “Silastic healing chamber.” The patient is now a year postoperative and doing very well with excellent nasal function and reconstructed columella.

Most observers who do not perform complex rhinoplasty will not understand the severity of this patient’s initial problem and the extent of the damage because most of the damage was on the inside of his nose. Once you look at the bottom of his nose and see the exposed dead cartilage grafts and massive intranasal mucosal defect, you can understand the extent of the defect (see video). This type of reconstruction is very complex and required using extraordinary reconstructive efforts including using his 8th and 9th ribs with attached native perichondrium, nanofat injections, Silastic healing chamber and over 70 ninety-minute hyperbaric oxygen treatments at 2.2 atmospheres pressure. This combination of these techniques and therapies resulted in a successful reconstruction at a year postoperatively. 👏🏼

(⚠️11-16) This patient presented with a deviated nose and nasal obstruction. She desired to have her nose straightened, ...
06/05/2026

(⚠️11-16) This patient presented with a deviated nose and nasal obstruction. She desired to have her nose straightened, and her dorsal hump reduced. She had a deviated septum that was blocking her airway. She was an ideal case for dorsal preservation using a low strip with asymmetrical letdown. I released her septum and resized it to fit into the septal window and fixed it to the nasal spine after releasing her nasal bones using foundation techniques. I removed the deviated bone in the back of her septum. I was able to tilt her axis deviation to the midline and also straighten her septum. I used structural grafting in her tip with a septal extension graft and lateral crural strut grafts with repositioning. This allowed me to align her nostrils and stabilize her lateral wall to maximize her nasal breathing. She is doing well fifteen months postoperatively with a straight nose and excellent nasal breathing. 👏🏼
Dorsal preservation using the low strip (SPQR) is very powerful for correcting the deviated nose. In the past, when I used structural rhinoplasty to try to correct these cases and I would have to place asymmetric spreader grafts to camouflage the deviation. Now I am actually straightening the septum to bring the nose to the midline. The operation is simplified and shortened in duration with better outcomes.
In most of my primary rhinoplasties, I use dorsal preservation for the hump and to straighten the nose and structural rhinoplasty for the nasal tip. The structure techniques are clearly described in my three-volume textbook, “Structure Rhinoplasty: Lessons Learned in Thirty Years. The preservation techniques are demonstrated in the new two-volume textbook, Structural Preservation Rhinoplasty, available on the and website. The structure techniques can also be found in my three volume textbook, “Structure Rhinoplasty: Lessons Learned in Thirty Years.”
toriumirhinoplastybook.com

In March of 2025, I presented keynote addresses and performed a “live” surgical demonstration at the meeting in Rio De ...
05/22/2026

In March of 2025, I presented keynote addresses and performed a “live” surgical demonstration at the meeting in Rio De Janeiro, Brazil. 🇧🇷
The patient I operated on had undergone prior rhinoplasties and was left with a severe deformity. Her nose was over-reduced with a scooped dorsum and over-rotated nasal tip. She had a filler injected into her nose as well, which complicated the surgery. I met the patient beforehand to discuss the surgical plan and the planned outcome. At the time of surgery, I had to remove a large amount of filler from the upper part of the nose (radix) that further complicated the reconstruction. I harvested a 6 cm segment of her 8th rib and performed a subdorsal cantilever graft to “push up” her dorsum and augment her radix. I also performed a reconstruction of her nasal tip using her rib cartilage in the form of a caudal septal extension graft and shield tip graft. It was a complex operation, but she has done very well and is now over a year postoperative with excellent nasal function, hear her testimony on slide 16 ➡️📹

“Live” surgery can be difficult as you are operating outside of your normal operating room space, and you are being observed by hundreds of participants. I was fortunate to have assistance from and .tiagolyrio in the operating room. These experiences are very rewarding, as you can help a patient while teaching your techniques. In this case, I used a structural preservation rhinoplasty hybrid operation.

📚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 website.
📕The new “Structural Preservation Rhinoplasty” textbook is available on the website.
🌴I also encourage you to join us in sunny South Florida for the fourth annual Preservation Rhinoplasty “The Course” that will be held December 11 to 13, 2026

I was recently in Cairo, Egypt, presenting two keynote addresses at the .face.summit 2026. The meeting was well attended...
05/15/2026

I was recently in Cairo, Egypt, presenting two keynote addresses at the .face.summit 2026. The meeting was well attended and very well organized.
My keynotes were on Structural Preservation Rhinoplasty and Revision Rhinoplasty. While in Egypt, I visited and toured the Pyramids and the Grand Egyptian Museum. I also toured Luxor, visiting the Valley of the Kings and the Karnak Temple. Such a rich history in these historic sites. 🇪🇬

I would like to thank Samir Ghoraba and Hani Nabil, the Founders of Cairo Face, and Ahmed Salah and Mohamed Elkady. Assistance from Muhamed Elshenawy and Habida Oussama was invaluable. Photos and videos by .tiagolyrio
I also thank the other members of the organizing committee. 👏🏼

(⚠️ 8-16) This 27-year-old female patient presented requesting rhinoplasty to treat her tip and dorsal hump. She is now ...
05/07/2026

(⚠️ 8-16) This 27-year-old female patient presented requesting rhinoplasty to treat her tip and dorsal hump. She is now 9 years postop and is doing very well with excellent nasal function. At the time of her surgery, I was not using dorsal preservation. I started using dorsal preservation in 2019. In this patient, I used a conventional component dorsal hump using a Joseph osteotome. I no longer use this instrument or this excision method, as I have adopted dorsal preservation with subdorsal work and letdown in most cases.
Even though she had a good outcome, she has some small dorsal irregularities. They are difficult to see in the photos but can be seen in certain lighting. This is one of the reasons why I have shifted to dorsal preservation, where the bone cuts are made toward the base of the nose and not along the dorsal line, where the skin is thinner. These patients do better in the long-term. I don’t raise the dorsal nasal skin for many patients.

Long-term follow-up is critical to fully assess your aesthetic and functional outcomes. Long-term follow-up is at least 10 years postoperatively. Patients and surgeons believe the nose is healed after a year. This is so untrue. I believe the nose will heal and change over the patient’s lifetime. I see changes occurring more than ten years after surgery. I believe this is due to scar contracture, reduction in swelling, and potential weakening or loss of the grafts. This is why I believe rib grafts should have native perichondium attached, as in the 9th rib. I tell patients their nose is only 30% healed at a year and up to 45% at two years. At ten years, they may be close to 70% healed with still more potential changes. This patient was lacking definition when I saw her at four months postoperative, but had much improved definition than when I saw her nine years postoperative, when she brought in a family member for surgery. This is why good structural integrity using the patient’s own rib covered with native perichondrium is so important. 👏🏼 👃🏼

(⚠️ 6-17) This patient presented with nasal deformity and nasal obstruction. She requested removal of the dorsal hump an...
04/30/2026

(⚠️ 6-17) This patient presented with nasal deformity and nasal obstruction. She requested removal of the dorsal hump and improvement of the tip shape. She had thin skin and a larger S-shaped dorsal hump.
Correction required using the open approach and a dorsal preservation technique. I chose a Ferriera Ishida cartilaginous pushdown with bony cap preservation. This technique works well on S-shaped dorsal humps. It involves releasing a portion of the upper lateral cartilage from the bone and then removing bone segments to allow the bony cap to collapse. Subdorsal work is needed to allow the bony cap to reduce. Then, conventional lateral osteotomies can be performed to set the bone width.
I used structural techniques in her tip because she had a concave lateral segment of the right lateral crus. This required releasing the lateral crura from the vestibular skin and placing lateral crural strut grafts. The dissected lateral crura were flipped to allow proper contours. Her skin was thin, so I placed a platelet-rich fibrin fat graft over her bridge (Milosevic). Then I performed bilateral alar flaps to downsize her nostrils.
👃🏼 She has done very well and is now over a year postoperatively with excellent nasal function.
Dorsal preservation can be broken down into surface and foundational techniques. I use both depending on the configuration of the dorsal hump. This patient had a larger S-shaped dorsal hump and was a great candidate for a surface technique to reduce the large hump.

In most of my primary rhinoplasties, I use dorsal preservation for the hump and structural rhinoplasty for the nasal tip. The structure techniques are clearly described in my three-volume textbook, “Structure Rhinoplasty: Lessons Learned in Thirty Years. The preservation techniques are demonstrated in the new two-volume textbook, Structural Preservation Rhinoplasty, available on the website. The artwork in this post is from the QMP book, and this technique is clearly described with full-length videos. 📚

(⚠️6-16) This 50-year-old patient presented after undergoing multiple prior rhinoplasties. She had prior Gore-Tex implan...
04/24/2026

(⚠️6-16) This 50-year-old patient presented after undergoing multiple prior rhinoplasties. She had prior Gore-Tex implants with infection as well. She had nasal obstruction and a deviated nose. Her primary concern was the deviation and obstruction. Her reconstruction required harvesting her own rib cartilage with attached native perichondrium. At the time of surgery, it was noted that the previously placed caudal septal extension graft was deviated to the left. The previously placed grafts were removed, and tall spreader grafts were placed and fixed to her nasal bones. A caudal septal extension graft was placed as well. This maneuver centered her tip. Then lateral crural replacement grafts were sutured to the caudal septal extension graft. Lateral crural strut grafts were placed to support the lateral wall of the nose.

She had some asymmetries of her nasal base with a high left alar insertion point due to left premaxillary deficiency. To correct this, I placed small cubes of cartilage under the left alar base. To improve the symmetry of her nostrils, I performed a right Y-to-V maneuver to better align them. Postoperatively, she had some asymmetries of her tip and a small dorsal prominence and required a minor revision surgery. This was performed three years after her initial surgery. She is now doing very well with nasal symmetry and excellent nasal function.

In approximately 15% of patients, I perform a minor revision surgery to improve the outcome. I encourage all of my patients to come for follow-up visits so we can try to maximize their outcomes. I typically see patients at 1, 3, 6, 9, and 12 months postoperatively. Although most of my patients are out of state or out of the U.S., most come back or at least are able to do virtual follow-up visits. Most patients who come for their follow-up visits show improvement in their outcome over time. If patients do not return for their follow-up for at least one year, problems can persist. If problems persist, I am happy to perform a revision procedure to achieve the desired outcome. Unfortunately, some patients do not come back for the one-year time period and go elsewhere for revision surgery. This is unfortunate, as I can frequently correct problems with a relatively minor surgery.

Revision nasal surgery is complicated, and sometimes additional minor surgery is necessary to get the desired outcome. These procedures can frequently be performed using a closed rhinoplasty approach. I can use the cartilage banked behind their hairline if needed. If the patient has realistic expectations, I am more than happy to get them to the desired outcome. Not returning for at least 1 year postoperatively does not allow me to achieve that maximized outcome.
With my new techniques, developed over the past three years, outcomes have become more consistent. I am excited about these techniques, which will be published soon. Some are already published in the new two-volume textbook, entitled “Structural Preservation Rhinoplasty” by QMP. Consider coming to the Marina Medical Cadaver Course in Florida, December 11 to 13, 2026.

This 18-year-old patient with a history of bilateral cleft lip, palate, and associated nasal deformity presented after u...
04/10/2026

This 18-year-old patient with a history of bilateral cleft lip, palate, and associated nasal deformity presented after undergoing five prior rhinoplasties.
He complained of nasal obstruction and nasal deformity. He has very thick skin and had a prominent supratip deformity. To help manage his thick skin, he was pretreated with Dupilumab (Dupixent), which blocks select inflammatory pathways and helps patients with thicker, inflamed skin. The Dupilumab treatments were administered in conjunction with Dr. Rania Agha, a dermatology colleague.

His reconstruction was complex and required using his rib cartilage and composite grafting from the ear to manage his short columella, which is a characteristic finding in bilateral cleft patients. A composite graft was also used to manage his notched right ala. Due to the risk of composite graft failure and also his young age, I used his 9th rib as a caudal septal replacement graft. I can use the 9th rib, leaving the native perichondrium attached, and avoid carving to prevent warping. He also underwent lateral crural strut grafting and shield-tip grafting. With the large increase in tip projection, his columellar incision could not be closed, and he had a 10 mm gap in his columellar closure. I placed a large composite graft from his ear to bridge the gap in his columellar closure using the perichondrial underlay technique to aid in graft survival. I placed a Silastic healing chamber to help with healing and also had him complete many 90-minute hyperbaric oxygen treatments (2.2 atm pressure) postoperatively.

He has done well one year postoperatively, with complete survival of the composite grafts and much-improved nasal breathing. His thick skin is better controlled with postop steroid injections and some additional Dupilumab treatments. His nose is red and inflamed in the photos, as his latest Dupilumab injection was eight months prior to this visit.

CONTINUED IN COMMENTS ⬇️⬇️

(⚠️9-16) This 19-year-old patient presented after undergoing two prior rhinoplasties. She was left with a wide nose and ...
04/03/2026

(⚠️9-16) This 19-year-old patient presented after undergoing two prior rhinoplasties. She was left with a wide nose and an asymmetric tip with left nasal bone deformities. Her reconstruction required using her own rib with attached native perichondrium, and placement of a single midline tall spreader graft, a splinted caudal septal extension graft, and lateral crural replacement grafts with lateral crural strut grafts. She wanted to keep her relatively small, shorter, more feminine nose shape. She wanted a narrower, more defined version of her existing nose with better tip symmetry and less nostril show. I was able to accomplish these changes and improve her nasal function as well. She is over a year postoperatively and doing well.

This patient presented requesting narrowing of her nose and improved symmetry. I frequently get these requests. Correction can be difficult because the nose does not look terribly deformed, but definitely has problems that can be improved. The question is always what approach to take in the correction. In the early years, I would simply try to tweak the existing structures to make the improvement. What I found is that the tweaked noses tended not to do well in the long term. I believe the reason is that I was modifying a flawed underlying nasal structure, and the nose can heal in an unpredictable manner. For the last twenty-five years, I have been reconstructing the nasal structure using the patient’s rib with time-tested techniques I have developed to provide a long-term aesthetic and functional outcome. 👃🏼

CONTINUED IN COMMENTS ⬇️⬇️

Very happy to participate as faculty at the Preservation Rhinoplasty meeting in Nice, France this past week. Dr Saban ha...
03/27/2026

Very happy to participate as faculty at the Preservation Rhinoplasty meeting in Nice, France this past week. Dr Saban has been our mentor and friend who taught us dorsal preservation and management of the dorsal hump in rhinoplasty. Great to be with friends and other experts in preservation rhinoplasty. Thanks to Yves and Sylvie and the team. 🇫🇷

Fantastic two day cadaver study session in Caen, France to refine and develop new techniques in rhinoplasty and dorsal preservation with friends and members of the IRRS. Great having Tiago Lyrio and Felipe Azevedo as our guests. Also great to visit the Caen Memorial Museum at Normandy, such a memorable historical site. 🛩️

📚 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

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