Prof. Dr. Miguel Gonçalves Ferreira

14/12/2025

Crural Cantilever Tip, Delta Graft, and Inverted Delta Graft

The way we shape the nasal tip has evolved significantly over recent years. The three-dimensional architecture of the final tip has progressively changed as a result of innovative solutions introduced by colleagues worldwide.

The strategy we currently perform and propose is the outcome of multiple refinements—some established, some newly introduced—that together lead to a stable and long-lasting tip result.

This strategy is based on two grafts and several key principles:

Inverted Delta Graft
Anchored to the septal extension graft (SEG)—or, in selected cases, to a long W-ASA—this graft allows definitive control of tip projection and rotation by stabilizing the natural domes.

Delta Graft
Anchored in the “W area,” slightly cephalic to the caudal upper lateral cartilages (ULCs), this graft allows precise positioning and shaping of the lateral crus, including control of shape, divergence, and eversion. This represents an evolution of the Gunter / .rohrich “alar spreader graft concept”.

Release of Soft Tissues
Soft tissues, including ligamentous structures and densifications, maintain the original anatomy that we aim to modify. Their release is essential to permit effective repositioning.

Release of the Lateral Crus
Complete release of the lateral crus—including its tail—from the skin and mucosa is crucial to avoid cartilage “memory.” Many technically sound maneuvers on the lateral crus fail in the medium term because the tail is not adequately released. Several colleagues have long adopted this approach, with special mention to

Avoidance of New Dome Creation
Creating new domes introduces new tension. Instead, the three-dimensional anatomy of the lower lateral cartilages (LLCs) should be repositioned as a single structural unit, preserving the original domes while relocating them to a new, stable position.

We hope this strategy will serve as an additional option for managing the consistently challenging outcomes associated with nasal tip surgery in rhinoplasty.

13/12/2025

Complex Revisional Rhinoplasty
🇵🇹 Português
Múltiplos defeitos para correção neste paciente.
Solução extremas novamente sem cartilagem de costela ou auricular.
A rinoplastia moderna tem como objetivo otimizar a função respiratória e aprimorar a estética nasal de forma integrada.
A abordagem atual prioriza preservação estrutural, estabilidade a longo prazo e resultados naturais, respeitando as proporções faciais e as características individuais de cada paciente.


⸻

🇺🇸 English
Multiple corrections in this extreme revisional case, with no ear or rib cartilage.
Modern rhinoplasty aims to optimize nasal function while enhancing nasal aesthetics in a balanced way.
Current techniques emphasize structural preservation, long-term stability, and natural outcomes, always respecting facial proportions and each patient’s unique anatomy.


⸻
العربية

تهدف عمليات تجميل الأنف الحديثة إلى تحسين وظيفة التنفس وتعزيز الشكل الجمالي للأنف بشكل متوازن.
تركّز التقنيات الحالية على حفظ البنية الأنفية، ضمان الاستقرار طويل الأمد، والحصول على نتائج طبيعية مع احترام نسب الوجه وخصائص كل مريض.

11/12/2025

TERCIARY COMPLEX REVISION - FILLOW-UP

🇵🇹 Rinoplastia feminina – nariz natural - revisão complexa
Pós-op precoce. Edema e pequenos detalhes vão melhorar nos próximos 2-3 meses.
Nariz sob tensão e torcido, múltiplas deformidades e pele fina.
Neste rosto elegante, vemos como as linhas estéticas dorsais e a vista de perfil são cruciais na .
Sem necessidade de costela ou orelha.
Paciente operada previamente por outros cirurgiões.
A relação dorso–supratip–ponta e columela–narinas foi refeita de acordo com o desejo da paciente.

🇬🇧 Female rhinoplasty – complex revision.
Tension nose, with dorsal hump,crooked and thin skin and many other múltiple defects.
The multiple defects, along with edema and other reactive changes, are expected to improve substantially over the next 2–3 months.”
Advanced Preservation Rhinoplasty – no rib, no ear cartilage.
The profile view best reveals the dorsal aesthetic lines.
DALs and columella/tip proportions were rebalanced according to the patient’s wishes.
Patient operated previously by other surgeons.

📍 Porto: 915 808 584 | Braga: 926 664 470

➡️ Estamos profundamente agradecidos a todos os pacientes que nos autorizam a divulgação das suas imagens reais com o fim educacional.
Todas as imagens, vídeos ou gráficos são protegidos por lei – © Prof. Dr. Miguel Gonçalves Ferreira – sendo proibida a sua utilização, reprodução ou distribuição sem autorização.
Comentários ofensivos ou inapropriados serão eliminados e os autores bloqueados.

➡️ We are deeply grateful to all patients who allow us to share their real pictures for educational purposes.
All images, videos, or graphic content are copyrighted © Prof. Dr. Miguel Gonçalves Ferreira and may not be used, reproduced, or distributed without permission.
Offensive or inappropriate comments will be deleted and the authors banned.

10/12/2025

Surgeon’s CV and Qualifications
Your surgeon is fully committed with knowledge acquired with scientific theoretical exchange and real surgery experience.
Following the patients, visiting colleagues, publishing papers and discuss ideas / difficulties with the peers is his philosophy.
His work is known among Facial Plastic Surgery community around the world.
and


Preservation Rhinoplasty
Spare Roof B
Do you want to change your nose shape?
Porto 915 808 584, Braga 926 664 470




Rinoplastia

10/12/2025

Prof Miguel Gonçalves Ferreira and his team performs all surgeries in the field of Facial Plastic Surgery
Rhinoplasty
Blepharoplasty
Otoplaaty
Chin Implant
Neck Lifting
Face Lifting
Lip Lifting
Fillers & Botox
Do you want to change your face?
Porto 915 808 584, Braga 926 664 470




Rinoplastia

10/12/2025

Result is what counts in Facial Plastic Surgery.
The surgeon must have experience in techniques and, most of all predict what might happen when one does a specific step in a specific anatomy.
The most important is the “Aesthetics of the Surgeon” - what does your surgeon likes? What does he/she wants for you?
I like natural noses - beautiful and functional.
These are some of my beauty results.

Do you want to change your face?

⚠️ Estamos profundamente agradecidos a todos os pacientes que nos autorizam a divulgação das suas imagens reais com o fim educacional.
Todos os comentários ofensivos ou negativos serão eliminados e os seus autores bloqueados.
Todas as imagens estão protegidas por lei - Prof.Dr. Miguel Goncalves Ferreira - pelo que é expressamente proibido o seu uso, reprodução ou distribuição sem autorização.

⚠️ We are deeply grateful to all patients that allow us to show their real pictures for teaching purposes.
All offensive or negative commentary will be deleted and the author banned.
All images are copyrighted © Prof.Dr. Miguel Goncalves Ferreira and may not be used, reproduced, or distributed without permission.

Porto 915 808 584, Braga 926 664 470




Rinoplastia

08/12/2025

Follow-up
Advanced Revisional Surgery
🇵🇹 Rinoplastia masculina
4a Rinoplastia de Revisao. Caso complexo já operado 3 vezes em vários países.
Necessidade reconstrução com enxerto de cartilagem de orelha e nanofat - gordura para estimular crescimento de novos tecidos.
Faz parte do tratamento a oxigenoterapia Hiperbarica.

🇬🇧 complex revisional rhinoplasty
Advanced Revisional Rhinoplasty - patient already had 3 surgeries in different countries.
Complex revision with auricular graft and Manofat - to increase development of new cels/tissues.
Final result Will improve a lot over time.
Hyperbaric Oxigenoyherapy is mandatory in this cases.

Do you want to change your nose and face?
Porto 915 808 584, Braga 926 664 470

➡️ Estamos profundamente agradecidos a todos os pacientes que nos autorizam a divulgação das suas imagens reais com o fim educacional.
Todas as imagens, vídeos ou gráficos estão protegidas por lei - © Prof.Dr. Miguel Goncalves Ferreira - pelo que é expressamente proibido o seu uso, reprodução ou distribuição sem autorização.
Todos os comentários ofensivos ou inapropriados serão eliminados e os seus autores bloqueados. Comentários tecnicos devem ser enviados por MP.

➡️ We are deeply grateful to all patients that allow us to show their real pictures for teaching purposes.
All images, videos or any graphic content are copyrighted © Prof.Dr. Miguel Goncalves Ferreira and may not be used, reproduced, or distributed without permission.
All offensive or inappropriate commentaries will be deleted and the author banned. Technqical comments must be made by PM.

07/12/2025

Revisional Rhinoplasty - no definition
Excessive fibrosis

🇵🇹 Reverse Spare Roof Technique - também conhecida. Por push-up , é uma técnica baseada nos mesmos princípios anatómicos e nos princípios da preservação mas indicada para a elevação do dorso.
Está indicada em narizes de etnia asiática ou negra e narizes vítimas de acidentes ou mesmo cirurgia prévia onde se perdeu o suporte do 1/3 médio e superior.
Conseguimos assim um dorso natural sem qualquer enxerto visível ou palpável.

🇬🇧 The subdorsal graft in the best strategy to support the Middle third while performing the Reverse Spare Roof Technique - rSRT
Prior descriptions of push-up rhinoplasty were performed with uncertain results, there so they were seldom accepted.
The keys to sucess are: 1)release the lateral keystone area; 2)release all the interior mucosa (downforces); 3) release the bonycap with an efective radix subdorsal greenstick fracture 4) provide a good structutral support under the roof based on a strong remaining septum.
When the roof is still present and the remaining septum is still strong, this is the elegant way to reconstruct the middle third with reliable results.
Normally we don’t use rib. We prefer remaining septum or ear cartilage since we only need structure bellow the old dorsum.
Published in the
Do you want to change your nose and face?
Porto 915 808 584, Braga 926 664 470




Rinoplastia

06/12/2025

03/12/2025

Complex Revisional Rhinoplasty
🇵🇹 Português
Múltiplos defeitos para correção nesta paciente.
Solução extremas novamente sem cartilagem de costela ou auricular.
A rinoplastia moderna tem como objetivo otimizar a função respiratória e aprimorar a estética nasal de forma integrada.
A abordagem atual prioriza preservação estrutural, estabilidade a longo prazo e resultados naturais, respeitando as proporções faciais e as características individuais de cada paciente.


⸻

🇺🇸 English
Multiple corrections in this extreme revisional case, with no ear or rib cartilage.
Modern rhinoplasty aims to optimize nasal function while enhancing nasal aesthetics in a balanced way.
Current techniques emphasize structural preservation, long-term stability, and natural outcomes, always respecting facial proportions and each patient’s unique anatomy.


⸻
العربية

تهدف عمليات تجميل الأنف الحديثة إلى تحسين وظيفة التنفس وتعزيز الشكل الجمالي للأنف بشكل متوازن.
تركّز التقنيات الحالية على حفظ البنية الأنفية، ضمان الاستقرار طويل الأمد، والحصول على نتائج طبيعية مع احترام نسب الوجه وخصائص كل مريض.

01/12/2025

4th Full Circle Rhinoplasty Live Surgery Course
Extreme advanced live surgery course organized by and .rhinoplasty
3 intensive days with 12 live surgeries, covering all techniques and demands in modern rhinoplasty with some of the best world surgeons.
Probably the most advanced rhinoplasty course.
Congrats to all team for being unique teachers and surgeons.hossam.foda .zholtikov and Wolfgang Gubisch.
It was an honor to demonstrate a few techniques - dorsum and tip - for such a distinguished faculty and attendees.
Male with thick skin and big hump and droopy tip as my case posted yesterday.
Modern technology and new strategies allow to solve all this cases with surface preservation techniques.
I’ve presented the NOVA Spare Roof and the new concept of Tip lateral crus Cantilever with the Delta Graft.
Thanks to all staff in the OR - to .ali_khazaal and
Final words to the marvelous staff that has made this happen and to .ge

30/11/2025

4th Full Circle Rhinoplasty Live Surgery Course
It was an honor to demonstrate few techniques - dorsum and tip - for such a distinguished faculty and attendees.
Make with thick skin and big hump and droopy tip.
Modern technology and new strategies allow to solve all this cases with surface preservation techniques.
I’ve presented the NOVA Spare Roof and the new concept of Tip lateral crus Cantilever with the Delta Graft.
Thanks to all staff in the OR - to .ali_khazaal and