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: info@toriumimd.com

This 25-year-old patient presented after suffering blunt trauma to his nose, resulting in a severe nasal fracture and de...
08/29/2025

This 25-year-old patient presented after suffering blunt trauma to his nose, resulting in a severe nasal fracture and deformity. He noted nasal obstruction, deviation, and flattening of his dorsum.

After an initial assessment, a decision was made to perform the repair in the acute stage. He was taken to surgery ten days after his injury. The possible disadvantages of early intervention were discussed with the patient. I discussed the possibility of needing rib cartilage to complete his repair. At the time of surgery, it was discovered that he suffered a septal fracture that was located along the upper septum under the middle vault. The fracture had a pattern similar to an intermediate-level dorsal preservation procedure. To utilize this septal fracture, an intermediate-level septal flap was overlapped on the side opposite the deviation to straighten his nose. A swinging door septoplasty was performed to straighten his caudal septum and to bring his tip back to the midline. He had a saddle nose deformity from the trauma that was repaired using the swinging door septoplasty and also by placing a bone graft from the vomer bone below the middle vault to raise and stabilize the dorsal strut. This maneuver corrected the saddle nose deformity. He also had a nasal bone fracture near the radix that was repaired via a small stab incision along the nasal dorsum.

The operation was performed using a closed approach, and no tip work was needed. The operation took less than two hours.
This case illustrates the power of dorsal preservation for treating nasal fractures. In the past, I would likely have used rib cartilage to correct his deformity. In this case, I was able to use an intermediate-level septal flap with swinging door septoplasty and bone grafting to the dorsal strut. The acute repair took advantage of the septal fracture and also allowed the patient to get back to work in a timely manner without deformity.

He is doing well, with excellent nasal function 8 months postoperatively, and has an improved profile compared to his preoperative contour with the dorsal hump.

More in the comments! ⬇️⬇️⬇️

(⚠️ 10-14)This patient presented with nasal deformity, nasal obstruction, and lateral wall collapse. The preoperative in...
08/22/2025

(⚠️ 10-14)This patient presented with nasal deformity, nasal obstruction, and lateral wall collapse.
The preoperative intraoperative nostril views show internal recurvature of the lateral crura bulging into the nasal airway bilaterally. The arrows on the nostril views show the bulging lateral crura. This caused nasal obstruction bilaterally. Correction required an open rhinoplasty approach with caudal septal extension graft, lateral crural repositioning, and placement of lateral crural strut grafts. The lateral crural strut grafts provided excellent lateral wall support with excellent nasal function twelve years postoperatively.

✍🏼Toriumi and published the functional results using lateral crural strut grafts with and without repositioning, showing dramatic improvement in nasal function with both. This patient demonstrated excellent improvement in nasal function with perfect NOSE and SCHNOS scores at twelve years postoperatively.
Long-term follow-up is critical to assess the efficacy of lateral wall and nasal valve support after rhinoplasty.

Unfortunately, a high percentage of patients undergoing rhinoplasty have worsening of their nasal function after surgery. It is imperative that the surgeon focuses on the functional considerations of the patient. I do not compromise nasal function for aesthetics. As a result, some of my patients are not happy with their nose early postoperatively as I have used techniques that will support the nasal airway with more widening and lateral wall fullness early postoperatively (lateral crural strut grafts). This is done to give the patient good long-term nasal function. This early compromise is important for the patients to keep in mind during the first two years after surgery.

I discuss lateral crural repositioning in the paper entitled “Lateral Crural Repositioning: Implications on nasal function” and in my three-volume rhinoplasty textbook. Lateral crural repositioning is also discussed in several chapters in the new two-volume textbook, “Structural Preservation Rhinoplasty,” which is available at the website

💡I encourage you to re-think reviews and seek information from verified sources and physicians.. ✍🏼
08/15/2025

💡I encourage you to re-think reviews and seek information from verified sources and physicians.. ✍🏼

This 23-year-old patient presented for rhinoplasty. She wanted to remove her dorsal hump and refine her nasal tip. She w...
08/13/2025

This 23-year-old patient presented for rhinoplasty. She wanted to remove her dorsal hump and refine her nasal tip. She was an excellent candidate for a closed with dorsal preservation and endonasal polygon tip surgery. I delivered her tip cartilages using an extended marginal incision and used polygon tip technique to manage her nasal tip. I used Tetris flap with a letdown to manage her dorsal hump. This complete preservation rhinoplasty operation is very sensible and works well in certain primary rhinoplasty patients.
She has done well at one year postoperative with a nice improvement in her nasal shape with good nasal function. 😊

As an open structure rhinoplasty surgeon for the past thirty years, making a change to use dorsal preservation and closed nasal tip surgery was a bit challenging. With help from Baris Cakir and , I was able to make the transition to closed polygon tip surgery. This is not the same closed rhinoplasty operation from the past. I use dorsal preservation with structure for the nasal tip in most primary rhinoplasties, but the complete preservation operation is very nice in certain candidates. The patients heal faster with minimal swelling and quicker recovery, and no external scars. 👏🏼

Learning and closed polygon tip surgery can be challenging and requires the surgeon to take a completely different approach to rhinoplasty surgery. The concepts and principles are very different and require an open mind and careful ex*****on.

👨🏻‍🏫 Learn this technique and more “The Course” in Fort Lauderdale November 14-16, 2025 (more in comments)

📕 The two-volume Structural Preservation Rhinoplasty textbook is available to pre-order at the website, and the book will be out later this year. All of the preservation techniques are demonstrated in this comprehensive textbook.

(⚠️ 7-13) This 21-year-old patient presented with septal perforation and nasal deformity after undergoing a prior septop...
08/07/2025

(⚠️ 7-13) This 21-year-old patient presented with septal perforation and nasal deformity after undergoing a prior septoplasty. He presented with nasal obstruction, dorsal hump, and droopy tip. His septal perforation was in a difficult position, very anterior, making closure more complicated. I used to reduce his dorsal hump using a Tetris technique, swinging door septoplasty with a letdown. I used structure in his nasal tip with a costal cartilage caudal septal extension graft and subdorsal spreader graft to raise his saddled middle vault. I used bilateral mucoperichondrial septal flaps with costal perichondrium with septal splints and a Silastic healing chamber over the perforation site. He has done well with closure of his perforation, reduction of his dorsal hump, and improved nasal tip position. 👃🏼

This combination of structure and preservation rhinoplasty was ideal for this patient and maximized the benefits from both philosophies to treat his nose. In the past, I would have performed a subtotal septal reconstruction. Using structural preservation rhinoplasty, I can simplify the operation and perform a caudal septal extension graft with dorsal preservation techniques, creating a stable reconstruction 👏🏼

Sign up for THE COURSE: bytm.org
I encourage you to come to Fort Lauderdale, Florida, from November 14 to 16, 2025, to learn from the masters at the Marina Medical "The Course" with top structure and preservation surgeons from around the world. A key to the course is to learn the use of the low strip SPQR technique, as it is the most powerful of the techniques, but is also the most complex. Learning on a fresh cadaver is the key to seeing the dynamics and learn the key points to avoid bad outcomes. The incorporation of this technique has been the biggest positive to my practice since starting dorsal preservation in June of 2019. This course allows you to work on three fresh heads over three days, learning high strip, bony work, intermediate strip, low strip, and closed rhinoplasty. "The Course" is more expensive than other courses because of the three fresh heads, with a new specimen each day. You will not experience this in any course due to cost issues. We do it because we believe you need a new specimen each day to learn all of the techniques. The lab experience is unmatched, and we provide one-on-one teaching at your respective lab stations.
The Structural Preservation Rhinoplasty book is coming out this fall and is available for pre-order at the QMP website. This is an outstanding book that covers both Preservation rhinoplasty and Structure rhinoplasty.

(⚠️9-18) This 64-year-old patient came requesting rhinoplasty after undergoing two prior reductive rhinoplasties. She pr...
07/31/2025

(⚠️9-18) This 64-year-old patient came requesting rhinoplasty after undergoing two prior reductive rhinoplasties. She presented with nasal obstruction and deformity. She had thick scarred skin in her tip. She also had a dorsal convexity and lateral wall collapse. For her repair, I used her own rib cartilage, leaving the native perichondrium attached to the cartilage. I left the native perichondrium attached to her caudal septal replacement graft and to the undersurface of the lateral crural strut grafts. Using this technique, I was able to reconstruct her tip and provide good nasal function and improved tip contour. She is doing well 15 months postoperatively with excellent nasal function.

I am amazed how many patients I see are told they are too old to use their own rib cartilage and that cadaver rib or ear is their only option. I do not use cadaver rib, and I prefer to only use ear for composite grafting of vestibular skin deficiencies. To create a long-lasting tip reconstruction, the patient’s own rib cartilage is essential. Whenever I use costal cartilage in older patients, I leave the native perichondrium attached to the harvested cartilage and carve the cartilage, leaving the perichondrium on at least one surface. In this case, I left the perichondrium attached to the right side of the caudal septal replacement graft and to the undersurface of the lateral crural strut grafts. This helps to promote the proper curvature of the lateral crural strut grafts to maximize the patient’s airway.

Continued in comments…⬇️

I am enjoying my visit to Lisbon, Portugal to teach at My Face Academy Rhinoplasty Meeting. 🇵🇹 On Thursday, I perform...
07/26/2025

I am enjoying my visit to Lisbon, Portugal to teach at My Face Academy Rhinoplasty Meeting. 🇵🇹

On Thursday, I performed a live surgical demonstration on a patient with a large dorsal hump and nasal obstruction. The case employed dorsal preservation and structure.

Yesterday and today, we dissected with participants in the cadaver lab. My good friend Carlos Neves and his great team organized a fantastic meeting. I am enjoying my time in Lisbon. It’s such a beautiful international city with outstanding food from the sea.

(⚠️ 12-14) This 17-year-old patient presented with severe nasal obstruction due to a deviated septum. He also wanted to ...
07/18/2025

(⚠️ 12-14) This 17-year-old patient presented with severe nasal obstruction due to a deviated septum. He also wanted to improve the appearance of his nose. His septum was severely deviated and was blocking his airway. I used a low strip SPQR dorsal preservation technique to correct his septal deviation and also to straighten his nose and reduce his dorsal hump.
He had a very complex nasal tip deformity. I used structural grafting with lateral crural repositioning to correct his nasal tip deformity. This combination of structure and dorsal preservation is a hybrid approach called “structural preservation rhinoplasty.” It combines structural rhinoplasty and the powerful low strip maneuver of preservation rhinoplasty. He has done very well at one year postoperatively with excellent nasal function. 👏🏼

The low-strip SPQR technique is the most powerful and versatile of the dorsal preservation techniques. This technique completely frees the quadrangular cartilage from all bony attachments (ethmoid, vomer, maxillary crest, and nasal spine), leaving it attached to the undersurface of the upper lateral cartilages. Many deviations in the septum and nose are due to an overly large septum that doesn’t fit into the designated septal window. The low strip SPQR allows for resizing the quadrangular cartilage to fit into the septal window, resulting in straightening of the septum and present to teach participants how to perform all forms of preservation rhinoplasty, including the low strip SPQR techniquethe nose.
👇🏼 more in comments

(⚠️ 11-14) This sixteen-year-old patient presented with a severe nasal deformity after suffering pressure necrosis of he...
07/10/2025

(⚠️ 11-14) This sixteen-year-old patient presented with a severe nasal deformity after suffering pressure necrosis of her columella from a nasal canula as a child. She has lived with this deformity for her entire life. Due to her age, use of a melolabial flap was not an option due to the scarring. In her case, the redundancy of her upper lip was incorporated in her repair. Her upper lip was relatively long and worked to our advantage as I was able to recruit her upper lip into her columellar closure. This concept is frequently used in rhinoplasty to shorten a long upper lip without using an upper lip lift incision. I harvested her eighth rib so I could use it in its native form without significant carving to prevent warping of the rib cartilage. I use this method in most younger patients to avoid postoperative warping. I also leave all of the perichondrium on the cartilage to protect the graft, maximize vascularization and also protect the graft should it become exposed due to breakdown of the columellar incision. I made a trough in the cranial margin of the graft to allow integration with the caudal septum. Additionally, I used lateral crural strut grafts with repositioning to support her alar margins. She has done well over the past two years and has excellent nasal function.

These cases are particularly gratifying for me as I am able to change people’s lives by correcting their severe cosmetic deformities. This gives the patient a boost to their self-esteem and confidence. I find this type of case particularly gratifying when performed in younger patients like this one. 🙏🏼

These techniques are covered in the Structural Preservation Rhinoplasty Textbook that will be released in October by Quality Medical Publishing. It is available for preprint pricing at the website.




(⚠️ 9-18) This 50-year-old patient presented after undergoing six prior rhinoplasties. After his first rhinoplasty in 20...
06/26/2025

(⚠️ 9-18) This 50-year-old patient presented after undergoing six prior rhinoplasties. After his first rhinoplasty in 2004, the surgeon injected filler into his tip, resulting in skin necrosis. He underwent several procedures to try to improve the appearance of his nose. Years later, he underwent another operation that resulted in necrosis of his columella after infection. He presented to us in 2021 requesting reconstruction of his nose. He did not want to undergo melolabial flap reconstruction, so I used a composite graft to reconstruct his columella. The composite graft did well and provided coverage for the columella. The patient wanted more nasal length and projection. Two years later, I added additional structure to lengthen his nose and project his tip. The columellar defect was almost 2 cm, requiring a local flap to provide adequate coverage. He preferred the forehead flap over a melolabial flap, so a forehead flap was used to reconstruct the columella. He has been successfully reconstructed with correction of his retracted columella with a significant increase in nasal length and tip projection over a year postoperatively. His nasal function is much improved as well.
A series of unfortunate events led to this patient’s deformities, which could have been prevented. I place antibiotic irrigation catheters to prevent postoperative infection after rhinoplasty (citation in comments). The use of the irrigation catheters eliminates the ability of bacteria to colonize and result in infection (video last slide). In most patients, I leave the catheters in place for five days. I will leave the catheters in for over a week or more for patients who have suffered prior infection. The patient places antibiotic-soaked gauze into their nasal vestibule after the catheters are removed. (Continued in comments)

(⚠️ 8-14) This 18-year-old patient presented for rhinoplasty a year ago. She had a larger nose with a dorsal hump. She w...
06/23/2025

(⚠️ 8-14) This 18-year-old patient presented for rhinoplasty a year ago. She had a larger nose with a dorsal hump. She wanted to have the tip refined and the hump removed. She was an ideal candidate for . I used a Tetris technique (Neves) for her dorsal hump. I used Baris Cakir’s endonasal polygon tip surgery to manage her nasal tip. She was an ideal candidate for the closed polygon tip surgery because she had strong, symmetric tip cartilages with good tip projection. She has done well and is at one year postoperative with excellent nasal function and a natural appearing nose. She has a strong chin, so I only slightly decreased her tip projection to balance with her chin projection.

I have been an open-structure rhinoplasty surgeon since I started my practice in July 1989. Since I started using preservation techniques in June 2019, I have been amazed at the improved outcomes and quicker recovery. Transitioning to dorsal preservation and then to closed polygon tip surgery was a big change for me as a completely structural surgeon since I started practicing. I still use primarily open rhinoplasty with structural grafting, but I use primarily dorsal preservation for the nasal dorsum. There is a subset of patients who are great candidates for closed rhinoplasty with no external incisions. I thank and , who helped me incorporate closed rhinoplasty into my practice.

📍 If you are interested in these techniques, you should strongly consider attending “The Course” put on by Inc. in Fort Lauderdale, FL, from November 14 - 16, 2025

📕 The new two-volume “Structural Preservation Rhinoplasty” textbook is now available at for preorder

(⚠️ 8-17) This patient presented for secondary rhinoplasty after undergoing prior rhinoplasty. She disliked the appearan...
06/12/2025

(⚠️ 8-17) This patient presented for secondary rhinoplasty after undergoing prior rhinoplasty. She disliked the appearance of her nose and has functional problems as well. She had a residual dorsal hump and septal deviation. I performed a Tetris and overlapped on the side opposite the deviation with a letdown. I also performed a swinging door septoplasty to straighten her septum. Costal cartilage was used to structurally stabilize her tip. I placed a caudal septal extension graft with lateral crural replacement grafts and lateral crural strut grafts. This stabilized the sidewall of her nose to correct her nasal valve collapse. She has done well and is a one-and-a-half years postoperative with excellent nasal function. 👏🏼

This case demonstrates how a hybrid structural preservation rhinoplasty approach can be used in . If the middle vault is intact with only prior rasping of the nasal bones, dorsal preservation can be used. In this case, I used Carlos Neves’ Tetris technique with a letdown. I used structure in her nasal tip. This Structural Preservation Rhinoplasty Approach was published in Plastic and Reconstructive Surgery in 2022.

In conjunction with , we are having “The Course” on preservation rhinoplasty from November 14-16, 2025, in Fort Lauderdale, FL. This course features some of the best surgeons teaching you at your station on fresh cadaver specimens over three days. This is a one-stop shop for learning preservation rhinoplasty. 👃🏼 🌴

The Structural Preservation Rhinoplasty two-volume textbook is coming out this September and can be preordered at the website at a prepublication discounted price. I hope to see you in Fort Lauderdale in November!

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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