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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

03/13/2026

(⚠️10-16) Dr. Paul Nassif came to me as a friend in 2013 to have his nose fixed. He underwent multiple prior rhinoplasties as well as resection of a basal cell cancer from the left side of his nose. This left a complex deformity where more than half of his left alar lobule was resected. Reconstruction of the nose required using his own rib cartilage to restructure his tip with a caudal septal extension graft, lateral crural replacement grafts, and lateral crural strut grafts. The most complex part of the reconstruction required harvesting large composite grafts to replace the missing skin of the left alar lobule and also to reline the missing vestibular skin. For the alar lobule, a large composite graft was used. To maximize composite graft survival, I used the “perichondrial underlay technique,” which involves trimming some skin from the graft so that half of the cartilage and perichondrium of the graft can extend under the cheek skin, enabling rapid vascularization.

He has done well and is now 13 years postoperative, and he looked great on his successful television program, “Botched.” He recently came to visit us and observe in surgery to learn dorsal preservation rhinoplasty using the low strip technique.

Revision rhinoplasty frequently requires complex grafting using composite skin and cartilage grafts from the ear. Once the ears are used for revision rhinoplasty, composite grafting is no longer possible. For this reason, I do not use ear cartilage for grafting for structural grafting. I only use the patient’s own rib cartilage for structural grafting with attached native perichondrium. Patients who present after undergoing a prior revision rhinoplasty using their ear cartilage are at a disadvantage for repair, as composite grafts may no longer be available. Fortunately, Dr. Nassif had his ears available, allowing me to reconstruct his deformed nose. If his ears were used previously, I would have to use a melolabial flap to fix the defect, which would have left a scar on his face and required a three-stage reconstruction.
CONTINUED IN COMMENTS ⬇️⬇️⬇️

03/04/2026

It was a pleasure to participate in .tiagolyrio NOSE Rio rhinoplasty course this past week in Rio de Janeiro, Brazil. 🇧🇷
I performed a “live” rhinoplasty surgical demonstration. The patient had a bulbous underprojected nasal tip and an asymmetric nasal base. I used a structural approach to manage her nasal tip with a caudal septal extension graft, lateral crural strut grafts, and a shield tip graft. Her skin was relatively thick, requiring the removal of soft tissue from the tip. I was able to improve her tip contour and increase her tip projection. I thank all of his staff, assistants, associates, anesthesia and operating room personnel who made the surgery seamless and provided top care for the patient.

I gave a Master Class on Structural Secondary Rhinoplasty before flying back to Chicago. I would like to congratulate my friend Tiago Lyrio on this successful rhinoplasty meeting. 👏🏼

02/27/2026

(⚠️15-17) This 34-year-old patient presented for rhinoplasty. He also complained of nasal obstruction. Correction required an open rhinoplasty approach with low strip septoplasty with a Ferriera-Ishida cartilaginous push-down with bony cap preservation. In this case, the patient had an S-shaped dorsal hump that required modification of the bony cap. The cartilaginous push-down with bony cap preservation is an excellent dorsal preservation technique to accomplish this. I used structure in the nasal tip with a caudal septal extension graft and tip suturing with an onlay tip graft. I used platelet-rich fibrin fat to camouflage the nasal dorsum (Kovacevic). The patient has done well and is now one year postoperative with excellent aesthetic and functional outcomes. 👏🏼

Structural preservation rhinoplasty is a very effective hybrid technique that allows the surgeon to use preservation methods on the dorsal hump and structural techniques in the nasal tip. By not disrupting the middle vault I do not have to place spreader grafts, and this leaves more septal cartilage for the structured tip. This combination of two very powerful rhinoplasty philosophies has improved my rhinoplasty outcomes.

📚 These techniques are demonstrated in my three-volume textbook entitled “Structure Rhinoplasty: Lessons Learned in Thirty Years,” and the new two-volume textbook entitled “Structure Preservation Rhinoplasty,” available at the website. The artwork in this post is from the “Structure Preservation Rhinoplasty Textbook.”

🌴 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 - 13, 2026.

02/20/2026

This patient presented at 42 years of age after undergoing four prior rhinoplasties. In one of the latest surgeries, MedPor spreader grafts were placed. She complained of severe nasal obstruction and deformity. The patient had collapse of her internal and external nasal valves. Her reconstruction required harvesting a segment of her seventh rib and reconstructing using a caudal septal replacement graft, spreader grafts, and lateral crural strut grafts. The MedPor implants were removed at the time of her surgery.

She is 17 years postoperative and doing well, with excellent nasal function and much-improved aesthetics.
The patient has minor asymmetries in the appearance of her nasal base on postoperative views. It is important for patients to understand that perfection in rhinoplasty is not possible. In fact, almost all patients have minor asymmetries and defects. When assessing a case, it is important to consider the patient’s preoperative nasal condition, the complexity of the operation, and the length of follow-up.
I find it interesting when I post a patient’s long-term outcome, and some will make remarks about the imperfections. Please consider the difficulty of the secondary rhinoplasty operation and the challenge of providing a result that lasts a patient’s lifetime. This patient is 17 years postoperative and will likely do well for the remainder of her life. This is a very important consideration when assessing the outcome after rhinoplasty. Imperfections are part of the process. You should also consider that the patents themselves may have different aesthetic requests that may not align with yours. This is the patient’s prerogative. I sometimes see commentary that someone likes the pre-op state better. This is likely not the case for the patient. Everyone’s aesthetics are different and must be considered when assessing long-term outcomes.

02/11/2026

(⚠️ 11-17) This 34-year-old patient presented after undergoing excision of a vascular lesion from her nasal tip at 7 years of age. She presents with a severely underprojected ptotic nasal tip. She also had very thick scarred skin, likely due to the prior vascular lesion.
Reconstruction required harvesting her rib cartilage and placing a large caudal septal extension graft with attached native perichondrium to protect the graft. A piezotome was needed to harvest her rib as it was partially calcified. Lateral crural strut grafts were placed as well to support the lateral walls and correct her airway obstruction. PRF fat (Kovacevic) was placed over the dorsum for camouflage. Kenalog 10 mg/ml was injected into her thick scarred nasal tip skin to help prevent postoperative edema and scarring.

She has done well just short of one year postoperatively with increased nasal tip projection and improved tip contour. She also has improved nasal function. 👏🏼

This case demonstrates how even patients in their thirties can have calcified rib cartilage. Using the piezotome, the cartilage was safely harvested and used for grafting. It is important to leave the native perichondrium attached to at least one side of the grafts to maximize vascular ingrowth into the grafts to prevent resorption.

These techniques are demonstrated in my three-volume textbook entitled “Structure Rhinoplasty: Lessons Learned in Thirty Years,” and the new two-volume textbook entitled “Structure Preservation Rhinoplasty,” available at 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.

02/09/2026

I was honored to be asked by to perform one of the “live” surgeries at the Finale Meeting being held this past weekend. 👨🏻‍⚕️
The surgery involved a very complicated primary rhinoplasty in a patient with a dorsal hump and complex nasal tip deformity with lateral nasal wall collapse. She had a severe nasal breathing problem that she dealt with her entire life. The repair involved using dorsal preservation for the dorsal hump and structure rhinoplasty for her nasal tip. I placed a caudal septal extension graft and lateral crural strut grafts. Her lateral crura were so deformed that it required resection and repositioning the lateral crura with lateral crural strut grafts. I needed some rib cartilage as well. She is doing very well day one after surgery and is already breathing much better through her nose.

I would like to congratulate Dr. Stuzin on what he has accomplished over forty years with the Baker Gordon Plastic Surgery Symposium that has trained thousands of plastic surgeons over the years. His contributions to the field of plastic surgery are immense. I would also like to thanks Dr. Stuzin’s staff for making the live surgery a positive experience.

02/08/2026

I was honored to be asked by Dr. James Stuzin to perform one of the “live” surgeries at the Finale Meeting being held this past weekend. 👨🏻‍⚕️
The surgery involved a very complicated primary rhinoplasty in a patient with a dorsal hump and complex nasal tip deformity with lateral nasal wall collapse. She had a severe nasal breathing problem that she dealt with her entire life. The repair involved using dorsal preservation for the dorsal hump and structure rhinoplasty for her nasal tip. I placed a caudal septal extension graft and lateral crural strut grafts. Her lateral crura were so deformed that it required resection and repositioning the lateral crura with lateral crural strut grafts. I needed some rib cartilage as well. She is doing very well day one after surgery and is already breathing much better through her nose.

I would like to congratulate Dr. Stuzin on what he has accomplished over forty years with the Baker Gordon Plastic Surgery Symposium that has trained thousands of plastic surgeons over the years. His contributions to the field of plastic surgery are immense. I would also like to thanks Dr. Stuzin’s staff for making the live surgery a positive experience.

02/05/2026

(⚠️ 9-16) This patient presented when she was 29 years old for septorhinoplasty. She had undergone a previous septoplasty, and her septal cartilage had been previously operated on. She wanted her nose straightened and her tip elevated. She also had significant tip asymmetries.
Once her nasal tip was exposed, it was noted that she had concave lateral crura. Correction required harvesting a segment of her seventh rib via a 1.2 cm chest incision. I performed a caudal septal replacement graft because her caudal septum was fractured and deviated. I removed the caudal septum and replaced it with a caudal septal replacement graft fixed into a notch in her nasal spine. I then stabilized this graft with bilateral spreader grafts. I used bilateral lateral crural strut grafts to correct her concave lateral crura and to support her lateral wall.
She recently came back to get checked out after she suffered trauma to her nose. Fortunately, her nose withstood the trauma, and she is doing well with very good nasal function sixteen years and seven months postoperatively. Using the patient’s own rib cartilage is resilient and durable, providing excellent aesthetic and functional correction over time. This is why I almost exclusively use the patient’s own rib cartilage for complex septal repairs and secondary rhinoplasty cases.

I published the first paper on caudal septal reconstruction in the Laryngoscope back in 1994. I have used this technique many times over the years and still use it in select cases. I also described this technique in my three-volume textbook entitled, "Structure Rhinoplasty: Lessons Learned in Thirty Years," which is available at toriumirhinoplastybook.com or the MarinaMedical.com.

Now I can manage many of these septal issues using a dorsal-preservation low-strip technique with septal bone stabilization, thereby avoiding the need to harvest rib cartilage. These techniques are clearly shown in the new two-volume textbook, "Structural Preservation Rhinoplasty", which is available at QMP.com. You can also learn the low strip technique at our fourth edition of the Marina Medical, "The Course" that will be held from December 11-13, 2026, in South Florida.

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.

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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