Open Rhinoplasty Surgery in Dallas, Texas | Dr. George A. Toledo,MD

Hello, this is doctor George Toledo, from the Highland Park Plastic Surgery Center in Dallas Texas. This is an educational video about my technique for an open rhinoplasty.


The photograph on your left is at the beginning of the surgery, and the right photograph is one and a half hours later, before the sutures and the cast is placed.


I would like to first illustrate the scar placement. Low on the columella and not in the middle where the resulting scar can be visible. I have placed the incision in this location for over 3,000 rhinoplasties over the last 34 years. I have never had to revise one.


This is a typical patient with an over projected nose and wide, boxy tip. This approach allows easy access to adjust these two deformities, as you can see in these illustrations.


Another advantage to this technique is opening the external valves to improve the nasal airway. As you can see she had small, narrow nostrils before, and now they're more oval. The columella is more narrow and the airway's improved.


Another advantage to placing the scar low on the columella is access you have for lowering the upper lip. As you can see these, overly projected noses pull the upper lip upwards giving you a gummy smile and more incisors show.


In conclusion, as you can see in this three month post-op photo the projection is decreased, the dorsal hump is removed, the lip is now lengthened and in a more natural location.

I want to give credit to doctor Fred Stucker, who taught me not only this low columella incision, but also how to perform a great rhinoplasty. Thank you and I hope this video was educational.