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 18-year-old patient with a history of bilateral cleft lip, palate, and associated nasal deformity presented after u...
04/10/2026

This 18-year-old patient with a history of bilateral cleft lip, palate, and associated nasal deformity presented after undergoing five prior rhinoplasties.
He complained of nasal obstruction and nasal deformity. He has very thick skin and had a prominent supratip deformity. To help manage his thick skin, he was pretreated with Dupilumab (Dupixent), which blocks select inflammatory pathways and helps patients with thicker, inflamed skin. The Dupilumab treatments were administered in conjunction with Dr. Rania Agha, a dermatology colleague.

His reconstruction was complex and required using his rib cartilage and composite grafting from the ear to manage his short columella, which is a characteristic finding in bilateral cleft patients. A composite graft was also used to manage his notched right ala. Due to the risk of composite graft failure and also his young age, I used his 9th rib as a caudal septal replacement graft. I can use the 9th rib, leaving the native perichondrium attached, and avoid carving to prevent warping. He also underwent lateral crural strut grafting and shield-tip grafting. With the large increase in tip projection, his columellar incision could not be closed, and he had a 10 mm gap in his columellar closure. I placed a large composite graft from his ear to bridge the gap in his columellar closure using the perichondrial underlay technique to aid in graft survival. I placed a Silastic healing chamber to help with healing and also had him complete many 90-minute hyperbaric oxygen treatments (2.2 atm pressure) postoperatively.

He has done well one year postoperatively, with complete survival of the composite grafts and much-improved nasal breathing. His thick skin is better controlled with postop steroid injections and some additional Dupilumab treatments. His nose is red and inflamed in the photos, as his latest Dupilumab injection was eight months prior to this visit.

CONTINUED IN COMMENTS ⬇️⬇️

(⚠️9-16) This 19-year-old patient presented after undergoing two prior rhinoplasties. She was left with a wide nose and ...
04/03/2026

(⚠️9-16) This 19-year-old patient presented after undergoing two prior rhinoplasties. She was left with a wide nose and an asymmetric tip with left nasal bone deformities. Her reconstruction required using her own rib with attached native perichondrium, and placement of a single midline tall spreader graft, a splinted caudal septal extension graft, and lateral crural replacement grafts with lateral crural strut grafts. She wanted to keep her relatively small, shorter, more feminine nose shape. She wanted a narrower, more defined version of her existing nose with better tip symmetry and less nostril show. I was able to accomplish these changes and improve her nasal function as well. She is over a year postoperatively and doing well.

This patient presented requesting narrowing of her nose and improved symmetry. I frequently get these requests. Correction can be difficult because the nose does not look terribly deformed, but definitely has problems that can be improved. The question is always what approach to take in the correction. In the early years, I would simply try to tweak the existing structures to make the improvement. What I found is that the tweaked noses tended not to do well in the long term. I believe the reason is that I was modifying a flawed underlying nasal structure, and the nose can heal in an unpredictable manner. For the last twenty-five years, I have been reconstructing the nasal structure using the patient’s rib with time-tested techniques I have developed to provide a long-term aesthetic and functional outcome. 👃🏼

CONTINUED IN COMMENTS ⬇️⬇️

Very happy to participate as faculty at the Preservation Rhinoplasty meeting in Nice, France this past week. Dr Saban ha...
03/27/2026

Very happy to participate as faculty at the Preservation Rhinoplasty meeting in Nice, France this past week. Dr Saban has been our mentor and friend who taught us dorsal preservation and management of the dorsal hump in rhinoplasty. Great to be with friends and other experts in preservation rhinoplasty. Thanks to Yves and Sylvie and the team. 🇫🇷

Fantastic two day cadaver study session in Caen, France to refine and develop new techniques in rhinoplasty and dorsal preservation with friends and members of the IRRS. Great having Tiago Lyrio and Felipe Azevedo as our guests. Also great to visit the Caen Memorial Museum at Normandy, such a memorable historical site. 🛩️

📚 The new “Structural Preservation Rhinoplasty” textbook is available on the QMP website.
🌴 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 to 13, 2026

(⚠️7–16) This patient presented for secondary rhinoplasty after undergoing multiple prior rhinoplasties. She requested i...
03/19/2026

(⚠️7–16) This patient presented for secondary rhinoplasty after undergoing multiple prior rhinoplasties. She requested improved symmetry and a narrower nose. Her reconstruction required using her own rib. I used lateral crural replacement grafts with lateral crural strut grafts to align her nostril margins. The native perichondrium was left attached to the undersurface of the lateral crural strut grafts to promote proper curvature. A lateral crural extension graft was used on the left side. A Y to V maneuver and subalar excision were needed, as well as other alar base work, to improve the position of her left nostril sill. A composite graft was used in her left marginal incision.
She is doing well two years postoperatively with improved symmetry and improved nasal function.
In 2024, I published a technique using lateral crural replacement grafts with lateral crural strut grafts to treat the unilateral cleft nasal deformity. I believe this technique is ideal to manage the asymmetrical tip in such patients. It gives the surgeon maximal control over tip symmetry. This is particularly effective when combined with lateral crural extension grafts. Unilateral cleft patients have both structural and soft tissue problems that require attention.

📚 These techniques are demonstrated in my three-volume textbook, “Structure Rhinoplasty: Lessons Learned in Thirty Years,” and in the new two-volume textbook, “Structure Preservation Rhinoplasty,” both of which are available on the website. The new “Structural Preservation Rhinoplasty” textbook is available on the website.
🌴 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 to 13, 2026

(⚠️10-16) Dr. Paul Nassif came to me as a friend in 2013 to have his nose fixed. He underwent multiple prior rhinoplasti...
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 ⬇️⬇️⬇️

It was a pleasure to participate in .tiagolyrio NOSE Rio rhinoplasty course this past week in Rio de Janeiro, Brazil. 🇧🇷...
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. 👏🏼

(⚠️15-17) This 34-year-old patient presented for rhinoplasty. He also complained of nasal obstruction. Correction requir...
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.

This patient presented at 42 years of age after undergoing four prior rhinoplasties. In one of the latest surgeries, Med...
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.

(⚠️ 11-17) This 34-year-old patient presented after undergoing excision of a vascular lesion from her nasal tip at 7 yea...
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.

I was honored to be asked by to perform one of the “live” surgeries at the Finale Meeting being held this past weekend...
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.

I was honored to be asked by Dr. James Stuzin to perform one of the “live” surgeries at the Finale Meeting being held t...
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.

(⚠️ 9-16) This patient presented when she was 29 years old for septorhinoplasty. She had undergone a previous septoplast...
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.

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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