The right approach depends on your anatomy and your goals. Dr. Buonassisi will utilize a series of carefully selected surgical techniques that gives you the most natural, lasting result for your specific case.
Whether you are researching preservation or ultrasonic rhinoplasty, weighing open versus closed, or exploring options for a specific concern — hump reduction, tip refinement, ethnic rhinoplasty, or revision — the Knowledge Hub and technique guides below are the right place to start.
A rhinoplasty is never about a single technique — it is about a series of carefully selected changes that Dr. Buonassisi — drawing on his extensive experience — determines are right for your anatomy, your skin thickness, your cartilage strength, and your specific goals. Most patients arrive with one concern in mind: a bump, a tip that lacks definition, a nose that feels out of proportion. The techniques below explain what is actually involved in addressing each one, and why the plan almost always extends beyond that first concern. Patients travel to 8 West Clinic from across Vancouver, the Lower Mainland, Victoria, Kelowna, Calgary, and across Canada. To go deeper before your consultation, visit the Rhinoplasty Knowledge Hub .
Each technique is described on its own terms — select any approach below to understand what it involves, who it suits, and how Dr. Buonassisi decides when to use it.
What patients often describe as a single concern usually involves a series of complementary manoeuvres. Dr. Buonassisi will explain exactly what is involved for your anatomy at consultation.
Precise bone reshaping with less trauma, less bruising, and a faster recovery.
Ultrasonic rhinoplasty uses a piezoelectric device — the piezotome — to reshape nasal bones using high-frequency ultrasonic vibrations rather than traditional chisels and rasps. The instrument cuts bone precisely while leaving surrounding soft tissue largely undisturbed.
Traditional bone work transmits force through the bone and surrounding tissue, causing bruising and swelling. The piezotome's ultrasonic energy is selectively absorbed by mineralized bone, sparing the soft tissue envelope. The result is typically less bruising, less swelling, and a faster recovery. It also allows finer, more controlled bone sculpting — particularly useful for narrowing the bony vault or refining the rhinion horns.
Patients requiring nasal bone work — osteotomies, hump reduction involving the bony dorsum, or rhinion horn reduction — who want to minimise bruising and recovery time. Not every rhinoplasty requires bone work; Dr. Buonassisi uses the piezotome selectively, only when bone reshaping is part of the plan.
Dr. Buonassisi uses the piezotome when the surgical plan includes bone-level changes and the patient's anatomy and goals would benefit from its precision. He does not use it as a default — it is one tool among several, chosen when it offers a meaningful advantage for that specific case.
The most significant advance in rhinoplasty in the past decade — conserving what works, refining what doesn't.
Preservation rhinoplasty is an advanced surgical approach that reshapes the nose by conserving the native nasal bridge (dorsum) and key ligaments rather than removing and rebuilding them.
By letting down the nasal bridge from beneath rather than cutting away the top, preservation rhinoplasty maintains the natural, smooth contour of your profile. This approach minimizes trauma to the overlying skin and soft tissues, which typically results in significantly less post-operative swelling and bruising.
Ideal for primary (first-time) rhinoplasty patients with a dorsal hump who have strong nasal cartilage and want to maintain the natural character of their nasal bridge.
Dr. Buonassisi evaluates your cartilage strength, septum structure, and skin thickness. If your anatomy is suitable, he will recommend preservation to conserve your natural anatomy; otherwise, a structured traditional approach is selected.
Reshaping the nasal tip for improved definition, projection, and proportion.
Tip refinement reshapes, rotates, or adjusts the projection of the nasal tip to improve its definition and proportion in relation to the rest of the nose.
A bulbous, drooping, or asymmetrical nasal tip can disrupt facial harmony. Refining the tip requires precise cartilage sculpting, suturing, or grafting to create a defined, natural-looking tip that holds its shape over time.
Patients who are satisfied with their nasal bridge but want to address a nasal tip that feels too wide, rounded, droopy, or overly projected.
Dr. Buonassisi assesses the thickness of your nasal tip skin and the strength of your lower lateral cartilages. He utilizes advanced suturing techniques and conservative cartilage sculpting to achieve a refined tip that looks natural and ages gracefully.
Smoothing the nasal bridge for a refined, balanced profile.
A dorsal hump is a prominence of bone and cartilage along the nasal bridge. Hump reduction lowers this profile line — either by excising the excess tissue (traditional approach) or by letting down the dorsum while preserving the native anatomy (preservation approach). The result is a straighter, more refined bridge that harmonises with the rest of the face.
A prominent nasal hump can dominate the profile and draw attention away from the eyes and lips. Reducing it restores facial balance — often with a dramatic improvement in the overall profile. It is worth noting that hump reduction in isolation is rarely the complete picture: lowering the bridge changes the proportions of the nose, and the tip almost always needs to be addressed at the same time to maintain harmony. A reduced bridge with an unchanged tip can look disproportionate.
Patients with a visible dorsal hump on profile view. In the vast majority of cases, hump reduction is planned alongside tip work — the two changes are considered together to ensure the result looks balanced from every angle, not just in profile.
Dr. Buonassisi evaluates the hump's composition (bone, cartilage, or both), the strength of the middle vault, and the patient's skin thickness. He determines whether a preservation let-down or traditional resection is more appropriate, whether osteotomies or spreader grafts are needed to close the roof, and what tip work — if any — is required to keep the nose in proportion after the bridge is lowered.
Enhancing your features while preserving the characteristics that define your heritage.
Ethnic rhinoplasty is a specialized approach that refines and balances the nose while preserving and respecting the patient’s unique cultural and ethnic heritage.
A standard, “one-size-fits-all” surgical approach can erase ethnic characteristics and create a result that looks out of place. This technique focuses on customized structural enhancements—such as building up a flat bridge or narrowing the nostrils—to achieve facial harmony without erasing identity.
Patients of Asian, African, Hispanic, Middle Eastern, or Indigenous heritage who want to refine their nose while maintaining their ethnic identity.
Dr. Buonassisi discusses your aesthetic goals in detail, focusing on what “natural balance” means to you. He evaluates your specific skin thickness and cartilage strength to select techniques that enhance your features while preserving your cultural heritage.
Subtle nasal refinements as part of a comprehensive facial feminization approach.
Rhinoplasty as part of facial feminization surgery focuses on creating a softer, more feminine nasal profile. This typically involves narrowing the nasal bridge, refining the tip, reducing a dorsal hump, and slightly rotating the tip upward — changes that feminize the overall facial silhouette.
The nose is central to facial gender perception. A bridge that is too wide or a tip that is too prominent can read as masculine even when other features have been feminized. Nasal refinement is one of the highest-impact changes in a feminization plan.
Transgender women and non-binary patients seeking a softer nasal profile as part of a broader facial feminization approach, or patients who simply want a more feminine nose regardless of gender identity.
Dr. Buonassisi assesses the nasal bridge width, tip projection, and overall facial proportions in the context of the patient's feminization goals. He discusses which changes will have the most meaningful impact and plans the procedure as part of the broader facial balance.
Correcting a deviated septum to restore natural airflow — performed in combination with cosmetic rhinoplasty with cosmetic rhinoplasty.
Septoplasty is a surgical procedure to straighten a deviated nasal septum — the wall of cartilage and bone that divides the nasal cavity. It is performed entirely inside the nose with no external incisions and is performed in combination with cosmetic rhinoplasty (septorhinoplasty).
A deviated septum can obstruct airflow on one or both sides, causing chronic congestion, mouth breathing, snoring, and sleep disruption. Correcting it restores natural airflow. When combined with rhinoplasty, the septum also provides cartilage that can be harvested and used as graft material for structural reconstruction.
Patients with a deviated septum who are also pursuing cosmetic rhinoplasty. Septoplasty at 8 West Clinic is performed exclusively as part of the cosmetic rhinoplasty procedure — it is not offered as a standalone operation.
Dr. Buonassisi evaluates the degree and location of the deviation, its impact on breathing, and whether cartilage harvest is needed for structural reconstruction. When septoplasty is indicated, it is incorporated into the overall rhinoplasty plan and performed in the same procedure.
Rhinoplasty for younger patients — considered once facial growth is complete.
Rhinoplasty for younger patients — typically between 15 and 18 — considered once facial growth is complete. The procedure uses the same techniques as adult rhinoplasty; what differs is the assessment process, parental involvement, and careful evaluation of psychological readiness.
Operating before facial growth is complete risks a result that changes shape as the face continues to develop. It is also important that the motivation comes from the patient themselves — not from external pressure — and that their expectations are realistic.
Younger patients (typically girls 15–16, boys 17–18, once growth plates have closed) who have a genuine, self-motivated concern about their nose and whose parents or guardians are supportive and involved.
Dr. Buonassisi takes a conservative approach with younger patients. He assesses facial growth completion, discusses motivations candidly with both the patient and their family, and will decline to proceed if he has any concern about readiness or external pressure. A parent or guardian must be present at all consultations and must consent to the procedure.
Full surgical access for complex cases, significant tip work, and revision surgery.
Open rhinoplasty uses a small, discreet incision across the columella—the tissue between the nostrils—allowing the surgeon to fully visualize and precisely adjust the underlying nasal structure.
The open approach provides unparalleled surgical access and visibility. This is essential for complex structural changes, extensive tip sculpting, and revision cases where absolute precision is required to achieve a stable, natural result.
Patients requiring significant structural changes, revision rhinoplasty, or complex tip refinement that cannot be safely achieved through internal incisions alone.
Dr. Buonassisi selects the open approach when the complexity of your goals or your anatomy requires direct visualization to ensure structural stability and aesthetic precision. The columellar scar is designed to heal flat and become virtually invisible over time.
Correcting unsatisfactory results from a previous rhinoplasty.
Revision rhinoplasty is a secondary procedure performed to correct structural, functional, or aesthetic issues resulting from previous nasal surgery.
Revision cases are highly complex due to the presence of scar tissue, altered anatomy, and often a lack of native cartilage. They require a deep understanding of reconstructive techniques to restore both breathing function and aesthetic balance.
Patients who are unhappy with the outcome of a previous rhinoplasty performed elsewhere or who have developed breathing difficulties after surgery.
Dr. Buonassisi conducts a highly detailed clinical assessment to determine the structural integrity of your nose. He explains what is realistically achievable, discusses whether ear or rib cartilage grafts are required, and provides an honest assessment of the complexity of your case.
Complete our pre-assessment and Dr. Buonassisi’s team will review your submission personally — before you ever step into the clinic.
What it is — Removes a measured strip from the cephalic (upper) edge of the lower lateral cartilages — the cartilages that form the tip and alar rims.
Why it matters — Reduces tip bulkiness and width. One of the most commonly performed tip manoeuvres, but requires restraint: over-resection weakens the alar rim and can cause long-term collapse.
What it is — Reduces how far the nasal tip projects forward from the face. Techniques include cartilage scoring, tongue-in-groove setback, or medial crural overlap.
Why it matters — Addresses a nose that protrudes too prominently. Often combined with tip rotation to achieve a more balanced profile.
What it is — Reduces the convex prominence along the nasal bridge — a combination of bone in the upper third and cartilage in the middle third. The hump is either excised (traditional resection) or lowered by letting down the entire dorsum while preserving the native anatomy (preservation approach).
Why it matters — The most commonly requested change in rhinoplasty. Reducing the hump alone is rarely the full picture — the middle vault, tip, and overall profile must all be considered together. Hump reduction without addressing the tip almost always creates a disproportionate result, which is why it is nearly always part of a broader surgical plan.
What it is — Controlled fracture of the nasal bones to narrow the bony vault or close an open roof after hump reduction. Performed through small internal incisions.
Why it matters — After removing a dorsal hump, the nasal bones are left separated — creating an open roof that must be closed by infracturing the bones inward.
What it is — A piece of cartilage (usually harvested from the septum) placed between the medial crura of the tip cartilages to create a stable foundation for the tip.
Why it matters — Adds tip support, projection, and definition. Essential in preservation rhinoplasty when tip support has been reduced.
What it is — Thin cartilage grafts placed between the upper lateral cartilages and the septum to widen the middle vault and maintain the internal nasal valve angle.
Why it matters — Prevents the pinched, inverted-V deformity that can occur after aggressive hump reduction. Also used to correct nasal obstruction.
What it is — A family of suturing manoeuvres — transdomal, interdomal, and lateral crural mattress sutures — that reshape the tip cartilages without removing tissue.
Why it matters — Allows precise tip refinement with minimal tissue disruption. Preferred over excision in preservation rhinoplasty.
What it is — Removes a small wedge of tissue at the base of the nostrils (alar wedge excision) or at the sill to narrow the base width or reduce flaring.
Why it matters — Addresses nostrils that are too wide or flare excessively. Often performed as a finishing step after tip and bridge work.
What it is — Straightens a deviated septum and harvests cartilage that can be used as graft material for struts, spreaders, or tip grafts elsewhere in the nose.
Why it matters — The septum is the primary donor site for rhinoplasty grafts. Correcting a deviation improves breathing while providing raw material for structural reconstruction.
What it is — Reduces the bilateral bony prominences on the lateral sides of the nasal bridge near the rhinion — the points where the nasal bones flare outward and create visible widening of the upper bridge.
Why it matters —Distinct from hump reduction, which addresses the dorsal profile line. Rhinion horn reduction narrows the bridge width when viewed from the front, refining the upper third without altering the profile height. Often performed in combination with osteotomies.
What it is — Adds projection, definition, or height to the nasal tip using a cartilage graft — typically a shield graft or cap graft harvested from the septum or ear — placed at the tip to increase its prominence and refine its shape.
Why it matters — Used when the tip lacks projection, appears flat, or needs structural support after other tip manoeuvres. Particularly important in ethnic rhinoplasty and revision cases where native tip cartilage is weak or has been previously altered. Rarely performed in isolation — tip augmentation is almost always part of a broader plan that addresses the bridge and overall balance.
What it is — Raises the height of the nasal bridge using a cartilage graft (typically diced cartilage wrapped in fascia, or a solid septal/rib graft) or, in some cases, a silicone implant placed along the dorsum.
Why it matters — Addresses a flat or low dorsum — a common goal in ethnic rhinoplasty where patients want to add bridge height while preserving their ethnic identity. The approach is always considered in relation to tip projection and facial proportions; augmenting the bridge without addressing the tip can create an unbalanced result.
Surgeon-authored guides covering technique selection, recovery, candidacy, and what to expect — written for patients who want to make an informed decision.
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