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Toriumi Facial Plastics

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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: info@toriumimd.com

01/30/2026

(⚠️ 11-16) This 35-year-old patient underwent three prior rhinoplasties and had severe nasal obstruction and deformity. Her nose was dramatically over-reduced, leaving a poorly supported skin envelope and no lateral wall or nasal valve support. Correction required using her own rib and tall spreader grafts, with caudal septal extension grafts, lateral crural replacement grafts, and lateral crural strut grafts. Her thick scarred skin was expanded, giving her much improved nasal function and improved aesthetics. I injected her thick skin with Kenalog 10 mg/ml and nanofat to recover her vascularly damaged skin. I also placed antibiotic irrigation catheters to prevent infection.

She is doing very well two years postoperatively with much improved nasal function after her reconstruction. We should always prioritize nasal function in rhinoplasty operations to provide good nasal breathing. This requires strong structural grafting and lateral wall support. This is particularly important in secondary rhinoplasty patients.

📚 The techniques described in this case are clearly illustrated in my three-volume textbook, “Structure Rhinoplasty: Lessons Learned in Thirty Years.” These techniques are also demonstrated in the recently released two-volume textbook “Structural Preservation Rhinoplasty,” available on the QMP website

01/23/2026

(⚠️11-16) This patient presented with a dorsal hump and bulbous nasal tip. Analysis of his dorsal hump reveals that he has a “pseudo hump.” His dorsal hump is most noticeable because of his low, deep radix. Improper management would have involved taking the dorsal hump down to flush with the low radix. It is always better to leave the nasal dorsum as high as possible to provide a good frontal view definition of the dorsum.
I accomplished this by performing a conservative surface rasping of the most prominent edge of the dorsal hump, then placing a larger radix graft above the hump to create a straight profile. This was a surface dorsal preservation operation with bony cap rasping and lateral osteotomies to narrow the bones. It was important to avoid foundational work to eliminate the possibility of dropping his already low radix. Placing the large radix graft allowed alignment of his profile.
I managed his tip with lateral strut grafts and repositioning to correct the internal recurvature of his lateral crura , which was causing some nasal obstruction (yellow arrow). The lateral crural strut grafts effectively stabilized his lateral wall, providing excellent nasal breathing at just under a year postoperatively. 👏🏼

Analysis in rhinoplasty is very important to achieving good outcomes. Not recognizing that the problem in this patient was his low radix could have been a big problem. Lowering his dorsum to the level of the low radix would have taken away his dorsal height, likely giving him a “washed out look” on frontal view.
Radix grafts are used only when the radix position is deficient, and their placement requires careful fixation and sizing.

📚 The techniques described in this case are clearly illustrated in my three-volume textbook, “Structure Rhinoplasty: Lessons Learned in Thirty Years.” These techniques are also demonstrated in the recently released two-volume textbook “Structural Preservation Rhinoplasty,” available on the QMP website. This patient underwent a structural preservation hybrid operation.

01/16/2026

(⚠️ 11-17) This 60-year-old patient presented for secondary rhinoplasty after undergoing two prior rhinoplasties that resulted in a saddle nose deformity.
She also had a skin necrosis in the right side of her nasal tip that left an unsightly scar in the right supratip area. She had severe nasal obstruction due to collapse and vestibular stenosis. Reconstruction required using her own costal cartilage with attached native perichondrium to protect the grafts. I placed a single midline tall spreader graft with a caudal septal replacement graft. I left the native perichondrium on the tall spreader graft, the caudal septal replacement graft, and the undersurface of the lateral crural strut grafts to promote proper curvature and to protect the grafts in case of exposure. I placed a PRF fat graft with platelet-rich plasma and fat on her dorsum for camouflage as described by Kovacevic. She had vestibular stenosis that required placing a composite graft to open the stenosis. I injected nanofat into her right supratip scar to improve the blood supply to the skin and improve the appearance of the depressed scar.

Postoperatively, she has done well, with excellent skin recovery, and the right supratip scar has improved dramatically with nanofat and postoperative hyperbaric oxygen treatments. Nanofat and HBO are critical to the success of these complex cases.

Leaving the native pericondrium attached to the costal cartilage grafts is essential to protect the graft and is particularly important when the blood supply is compromised or the risk of infection is high. The native perichondrium also enhances vascular ingrowth into the denser calcified rib cartilage, helping prevent resorption over time.

This patient was at very high risk for skin necrosis due to her previous skin necrosis. With the nanofat I was able to recover the skin and dramatically improve her skin quality. Most importantly, I was able to reconstruct her nose in a single operation without infection or complications.
👏🏼👏🏼

01/01/2026

🥂 Here’s to a great New Year! Invest in your health this year by incorporating anti-inflammatory habits into your routine.
Ready to take the 30 veggie challenge? Drop a 🙋🏻‍♂️ in the comments below.

12/24/2025

(⚠️10-18) This 18-year-old patient presented with nasomaxillary hypoplasia (Binder’s Syndrome). This involves a deficiency in the bones around the base of the nose, requiring major augmentation. In this case, I used a large segment of her 7th rib, incorporating both cartilage and bone. I used the piezotome to remove the large rib segment. I fashioned a bone/cartilage premaxillary graft with a notch to fit over her premaxilla and also to allow integration with a larger caudal septal extension graft. This two-graft combination augmented her maxilla and significantly projected her nasal base and tip. I also performed lateral crural release with lateral crural strut grafts to allow maximal shaping of the nasal tip and to provide strong lateral wall support. The patient is now 2 years postoperatively, with excellent nasal function and much improved nasofacial relationships.

This case illustrates the importance of understanding the impact of augmenting deficient skeletal landmarks to maximally correct congenital deformities. These principles also apply to the management of the cleft nasal deformity. Use of the patients’ own rib cartilage is critical to ensure a lifelong correction that will persist as the patient ages.

The techniques described in this case are clearly illustrated in my three-volume textbook, “Structure Rhinoplasty: Lessons Learned in Thirty Years.” These techniques are also demonstrated in the recently released two-volume textbook “Structural Preservation Rhinoplasty,” available on the website. The video of this patient’s case is available via the video stream link included with the purchase of this book. (18)

🙏🏼These cases are what make rhinoplasty such a gratifying operation to perform, as they enable the surgeon to achieve dramatic improvements in patients’ noses. I feel blessed to be able to change patients’ lives with the skills that God has given me on this day before Christmas. Merry Christmas and Happy Holidays to all. 🎄🎄🎄

12/19/2025

This patient presented for rhinoplasty and closure of her septal perforation. She underwent two prior rhinoplasties and developed a septal perforation after the latest surgery. She had a relatively large septal perforation measuring over 2 cm in diameter. She had symptoms of crusting, nasal obstruction, and nosebleeds. She also had a foul smell in her nose.
Her reconstruction required harvesting her own rib and costal perichondrium, as well as nanofat. For larger septal perforations, I raise bilateral pedicled septal flaps to rotate into the perforation and then place a costal perichondrium interpositional graft with thin costal cartilage between two pieces of the perichondrium. I placed a costal cartilage caudal septal replacement graft, lateral crural strut grafts, and tall spreader grafts. I harvested fat from the periumbilical area and processed it into nanofat. The nanofat was injected into the perichondrial interpositional graft, and then it was placed between the septal flaps.

I placed a Silastic healing chamber over the septal perforation closure. Their special type of Silastic sheeting with Silon helped speed mucosalization over the interpositional graft. The septal splints were left in place for two months to allow for complete healing over the graft. The septal perforation was successfully closed with excellent nasal function. Her nasal esthetics were improved as well.

In this case, the septal perforation was due to prior surgery. Damage or thinning of the septal flap can result in this problem. She was having symptoms from the perforation, which necessitated closure. In this case, the combined use of pedicled septal flaps, injections of nanofat around the transpositional flaps, and hyperbaric oxygen therapy enabled successful closure of the septal perforation. This patient underwent ten 90-minute sessions at 100% oxygen and 2.2 atm pressure.

Healing of septal perforations can be complex, as the periphery of the perforation can be atrophic, making the actual size of the perforation larger. In some cases, we will not attempt closure if the area surrounding the perforation is atrophic, as the likelihood of successful closure is lower. The Silastic healing chamber helps to promote healing and improve nasal function. Septal perforations can cause crusting, nose bleeds, obstruction, and bad nasal smells. If possible, I try to close septal perforations less than 2 cm. The combination of a costal perichondrium interpositional graft with a thin rib graft and nanofat, along with postoperative HBO, can help maximize healing. The thin sliver of costal cartilage between the two sheets of perichondium helps to prevent late reperforation. I frequently close septal perforations at the same time as secondary rhinoplasty reconstruction.

These techniques are discussed in a paper I published on using costal perichondrium for perforation closure and also in my three-volume textbook, entitled, "Structure Rhinoplasty: Lessons Learned in Thirty Years." These methods are also covered in the two-volume textbook, Structural Preservation Rhinoplasty, that was just released by Quality Medical Publishing.

12/05/2025

We are gathering in Bogotá Colombia to teach at the Face and Nos e Institute Curso Rinoplastia. , and have done a great job with the organization of the meeting. 💥✨

I was able to give Keynote Addresses on Structural Preservation Rhinoplasty and Secondary Rhinoplasty. I was joined by other world class faculty and a very interested group of participants. The meeting will finish tomorrow with a fresh cadaver lab. Last night we enjoyed a lively night at Andres D.C. Bogota.
The theme of the meeting was D.C. League of Superheroes, or in this case “The Rhinoplasty League.” 💫💫💫

12/05/2025

11/26/2025

(⚠️10-14) This patient presented after undergoing two prior failed rhinoplasties. She also had severe nasal obstruction and extremely thick, sebaceous skin. Examination of her nose revealed an amorphous tip and inadequate tip projection. To manage her thick, sebaceous skin, we treated her with Dupilumab (Dupixent, ).
Her reconstruction involved using her own rib cartilage with a caudal septal extension graft, tall spreader grafts, lateral crural replacement grafts, and lateral crural strut grafts. I injected her thick skin with intradermal Kenalog (10 mg/ml) in the tip and supratip at the end of the surgery. Postoperatively, she was placed on an anti-inflammatory diet, and she went for daily hyperbaric oxygen treatments.
When her cast was removed on postoperative day 7, her nose looked good despite her thick skin. Her nose continued to improve over time with continued Kenalog injections and periodic Dupilumab injections. Postoperative ultrasound exams revealed a thinner tip and supratip skin. She is doing very well with excellent nasal function ten months after her surgery, and both aesthetics and function continue to improve. 👏🏼
CONTINUED IN COMMENTS ⬇️⬇️

11/19/2025

Working with Marina Medical, we were able to complete the third , ‘The Course’ in Fort Lauderdale, Florida. 🌴

The meeting was a resounding success with very positive feedback from the participants. We were maxed out on the space with all stations filled and a packed lecture hall. Each participant had the opportunity to view presentations, dissections, and one-on-one teaching by some of the world’s best preservation rhinoplasty surgeons.

The faculty went from table to table to teach the students how to execute the preservation techniques. The unique aspect of this course is that each participant and partner dissects at a station with a new head each morning. The first day was high strip with anatomy and bony work. The second day was endonasal polygon tip with intermediate-level flaps (Tetris and subdorsal Z-flap) and surface work, and the last day was devoted to low-strip SPQR with more bony work. The course covered each technique in depth over the three days. Each participant essentially performed the operations on the heads at their stations. The faculty was fantastic and very helpful to the participants.

The Marina Medical staff was outstanding and executed the meeting to perfection. Thank you, Jeff, Alex, Enrico, Gabiel, and the rest of the crew. Thank you, Ezra, for the excellent AV work. Your hard work was responsible for the course’s success. 👑

Thank you to the sponsors, QMP, Acteon, W and H Med, Bilumix, Hanson, Facial Plastic Surgery & Aesthetic Medicine journal and of course, our hosts, Marina Medical.

Special thanks to the world-class faculty and my co-director, Aaron Kosins, who helped edit the newly released two-volume Structural Preservation Rhinoplasty book that was introduced at the meeting this past weekend. Great work, Andrew, Amy, Mason, Carol, and Carolyn. The books look fantastic and available at the QMP website.

I would also like to thank the participants who demonstrated determination to help one another and an intense desire to learn everything possible about preservation rhinoplasty. Good luck with your use of preservation rhinoplasty in your practices.🥂

11/13/2025

(⚠️9-17)This 26-year-old patient presented after undergoing prior rhinoplasty. She suffered an infection postoperatively that persisted for several weeks. After the infection cleared, she noted gradual deformation of her nose with severe retraction of her left ala. The deformity got progressively worse over a year’s time, also causing severe nasal obstruction.

When she was first seen, a needle stick test was performed to assess the blood supply to her nasal skin. The blood supply was sluggish at best, and she was asked to perform nasal stretching exercises to stretch the scarred skin. When she was seen again, her skin had stretched nicely, and the blood supply was improved. She eventually underwent reconstructive rhinoplasty using her own rib cartilage and composite grafts from her ear. Nanofat injections were injected into her tissues to promote healing and composite graft survival. I discussed using a nasolabial flap for her reconstruction, but I was hopeful that we could use a large composite graft from the ear as an alternative. After the left alar margin was released, a very large intranasal vestibular skin defect was noted. I opted to use a large composite graft (almost 2 cm in size) for the repair. When using large composite grafts, I use a perichondrial underlay technique, nanofat injections, and hyperbaric oxygen treatments. She underwent over 20 post-op HBO sessions.

This combination was successful, allowing the large composite graft to heal. The nose could not be lengthened to the optimal degree due to the tautness of the skin envelope and scarred internal lining. If further lengthening were to be achieved, a melolabial flap would be needed.

This combination was successful, allowing the large composite graft to heal. The nose could not be lengthened to the optimal degree due to the tautness of the skin envelope and scarred internal lining. If further lengthening were to be achieved, a melolabial flap would be needed.

Special maneuvers used in this case to allow proper healing were as follows:
1. Harvesting of her own rib cartilage with attached native perichondrium to protect the grafts and to promote vascularization despite the diminished blood supply to the tissues.
2. Use of tall spreader grafts, caudal septal replacement grafts, and lateral crural replacement grafts with lateral crural strut grafts to make a new nasal structure.
3. Use of the perichondrial underlay technique to allow a very large composite graft (2 cm) to survive in a field with diminished blood supply.
4. Use of nanofat with HBO to enhance healing with stem cells.

When managing these complex cases, small details in ex*****on are critical to the success of the operation. The combination of HBO and nanofat was key to this patient’s favorable outcome. The patient is doing very well a year postoperatively with excellent nasal breathing.

These techniques are discussed in my three-volume textbook entitled "Structure Rhinoplasty: Lessons Learned in Thirty Years." The most recent techniques are discussed in the two-volume textbook "Structural Preservation Rhinoplasty," which is presently available on the Quality Medical Publishing website.

11/07/2025

This 38-year-old patient presented after undergoing two prior rhinoplasties. She has thin skin that contracted after her latest surgery. This left her with atrophic thin damaged nasal skin with multiple irregularities on her dorsum and tip. She had some saddling of her dorsum as well. Her revision nasal surgery required using her own rib cartilage and reconstructing using a caudal septal replacement graft with lateral crural replacement grafts and lateral crural strut grafts. To manage her thin atrophic skin, I placed a platelet-rich plasma diced fat (PRF fat) onlay graft as described by .miloskovacevic. This technique is very effective for managing patients with thin skin. She has done well and is over a year postoperative with excellent nasal function and good contour. I will continue to follow her for years to come.

Over the past month, I have discussed managing patients with thick skin. Thick skin is a difficult problem, but thin atrophic skin is an even bigger problem. Patients with thick skin tend to improve over time if followed closely and managed as we have recently described. On the other hand, patients with thin skin can contract and worsen over time. I see many patients who are referred to me with thin skin who do well for a couple of months and then deteriorated over time. Presently, I slightly overcorrect these patients to accommodate the contracture that can develop over the years. I am also using the PRF fat to thicken the skin envelope. Patients tend to be a little wider early on and improve over time. I tell patients that this is a process, and if you would like a good long-term outcome, you have to sacrifice a bit early on. Patients will see the gradual improvement over time. The casual observer may see this nose as somewhat big, but I am sure it will gradually improve in shape over time. You can see in the sequential frontal view images how the nose is shrinking over time.
What I have found is that the nose tends to stabilize around 2 years postoperatively if the shrinkage is managed. We can accomplish this with nanofat, HBO and Dupixent treatments (Agha/Toriumi). Additionally, the PRF fat helps to stabilize the skin envelope. Conquering thin skin and contracture postoperatively in revision cases is likely the final frontier in rhinoplasty.
These techniques are discussed in my three-volume textbook entitled "Structure Rhinoplasty: Lessons Learned in Thirty Years." The most recent techniques are discussed in the two-volume textbook "Structural Preservation Rhinoplasty," which is available on the QMP website. The premiere of this book will be at the Marina Medical Cadaver Dissection Course, from November 14 to 16, 2025, in Fort Lauderdale, Florida. Those who attend will get a discounted signed copy of the book, as many of the coauthors will be present at the meeting.

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60 E Delaware Place Ste 1425
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Dr. Toriumi is board certified by both the American Board of Otolaryngology and the American Board of Facial Plastic & Reconstructive Surgery, certifying him in all areas of facial plastic and reconstructive surgery. At Toriumi Facial Plastics, we work as a team to realize a shared vision of uncompromising excellence in medical and surgical care. Visit our offices: 60 E. Delaware Pl. , Suite 1425, Chicago, IL, 60611 *By sharing your photos, videos, reviews or comments on our page, you are giving us permission to repost here on Facebook and on our other social networks. See t’s and c’s: http://bit.ly/2a9EeFl

Toriumi Facial Plastics

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