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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

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.

10/29/2025

(⚠️ 8-12) This 26-year-old patient presented for secondary rhinoplasty after undergoing one prior rhinoplasty. She had an amorphous appearing nasal tip with poor definition and a lack of tip projection. She was treated using her own rib cartilage, placing a strong caudal septal replacement graft that was splinted to keep it straight. I then placed a shield tip graft with articulated rim grafts. I rarely use rim grafts, but they work well in patients with thicker skin, no alar retraction, and no obstruction. Patients who have alar retraction and thinner skin are treated with lateral crural strut grafts and lateral crural replacement grafts. Shield tip grafts were initially introduced by Jack Sheen.

In 1989, I published “Open Structure Rhinoplasty” with Calvin Johnson, who was using shield grafts in most of his cases. I still use shield grafts primarily in patients with thicker skin. In these cases, shield grafts can create a natural yet defined tip contour. The articulated rim grafts provide the lateral wall support and help to prevent alar retraction. I do not use this combination in patients with thin or medium-thickness skin.

When operating on patients with thicker skin, it is critical to maximize tip projection to "stretch" the skin envelope. Patients with thicker skin require maximal tip projection. This can be better understood by likening the nasal skin to a thick fabric. If you place a small sculpture under the thick fabric, you will not detect it. If you place a larger, taller sculpture under the thick fabric, the fabric will stretch over it, revealing the sculpture beneath. This same thought process is applied to thick skin rhinoplasty patients, projecting the structure (shield tip graft) into the thicker skin to create a better tip contour. In these cases, we make a bigger nose on the lateral view to achieve a narrower nose on the frontal view. In this case, the patient had a "pseudohump," meaning that the hump you see preoperatively is due to inadequate tip projection. In this patient, no hump was removed; instead, the nasal tip was projected to stretch the thick skin. I try not to compromise the frontal view by making the lateral view too small in patients with thick skin.

We also treat the patient with intraoperative and postoperative steroid injections and postoperative hyperbaric oxygen treatments. In the last two years, we have been treating patients with thicker skin with Dupilumab (Dupixent) to decrease inflammation and improve outcomes. Dr. Rania Agha and I will be publishing our data on this work later this year. These modalities allow us to better manage rhinoplasty patients with thick skin.
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.

10/23/2025

🔊🔊🔊🔊
The Marina Medical Cadaver Dissection Meeting, “The Course,” is less than one month away.
A group of the top rhinoplasty surgeons who specialize in preservation rhinoplasty will be in Fort Lauderdale, Florida, teaching one-on-one to the participants.
The key features of this meeting are the fresh heads every day over three days for each dissection station. That allows each participant to perform high strip, intermediate strip, and low strip with all of the bony work on a fresh specimen. You will have performed all three operations on three specimens over the three days. This is the best way to learn preservation rhinoplasty. 👃🏼

is becoming more popular and recognized by patients as the best way to treat a dorsal hump and the deviated nose. This less-invasive method for hump removal and nasal straightening will change your practice forever. Come to the course and learn the techniques so you avoid suboptimal outcomes. One key is to learn the low strip technique, which is the most powerful but also the most difficult to learn. You must learn this technique on a fresh cadaver specimen before doing it on a patient.

✈️ Come join us in Fort Lauderdale, November 14 to 16, 2025. I look forward to seeing you there. Don’t wait, as this may be the last opportunity to learn in this format.

10/22/2025

(⚠️ 10-16) This patient presented with nasal deformity and nasal obstruction requiring nasal reconstruction using her own rib cartilage. I used a caudal septal extension graft with spreader grafts and lateral crural strut grafts. She is now 11 years postop and doing well, with excellent nasal function. Despite her thick skin, I was able to gain good tip definition that has persisted for over ten years.

I believe it is important to post long-term follow-up photographs of my patients to show how their own rib cartilage holds up over time when using these techniques. This is very important to the patient. Most of the patients I see in consultation have been operated multiple times by multiple surgeons. It is common for the patients to tell me that their nose initially looked good but changed dramatically over time, resulting in deformity and nasal obstruction. This may be due to the use of less-than-optimal grafting materials and techniques that do not withstand the test of time. I do not use cadaver rib or ear cartilage (unless for composite grafting) for complex structural grafting in revision rhinoplasty. Long-term follow-up is critical to ensure that the techniques you use will provide the patient with a result that lasts a lifetime.

If you look at the patient critically, you can find some imperfections. I have never had a perfect outcome after rhinoplasty. I have made many adjustments to my technique to get better results now compared to ten years ago. The reason to show the long-term outcome is to allow patients to see that they can achieve significant improvement in their nasal shape and function over the long term.

📚 The techniques described are noted in my three-volume textbook, entitled “Structure Rhinoplasty: Lessons learned in thirty years.” The new two-volume “Structural Preservation Rhinoplasty textbook is coming out and will be available in November of this year, and is available at the website.

10/21/2025

I had a great experience going back to Morelia, Mexico, for the 46th Congress. I saw many friends I hadn’t seen in years and thoroughly enjoyed their company. 🇲🇽
The meeting topped off a successful FESORMEX Presidency of my friend Roberto Davalos. The organization was impeccable, and the participants were outstanding. I gave keynote presentations on secondary rhinoplasty and structural preservation rhinoplasty. I was also happy to see friends and mentors Yves Saban, J. Regan Thomas, and Aldo Stamm.

My keynote presentation on structural preservation rhinoplasty sparked significant interest in the upcoming Marina Medical Cadaver meeting, “The Course,” from November 14 to 16, 2025, in Fort Lauderdale, Florida.

Many participants were attracted to the three-day meeting with a fresh cadaver head each day, covering high strip, intermediate strip, and low strip, with all the bony work. This is the best way to learn preservation rhinoplasty and then incorporate it into your practice. The meeting is approaching quickly, and spots are filling up. 🏃🏼

Also consider getting the new two-volume Structural Preservation Rhinoplasty textbook from

10/10/2025

(⚠️8-18) This 37-year-old patient presented for secondary rhinoplasty after undergoing prior rhinoplasty. He wanted his nose to be made more masculine and also to correct his nasal obstruction. He also had a small septal perforation that caused turbulent airflow and a whistling noise when he would breathe in through his nose.
The septal perforation was successfully closed using a bilateral mucosal flap transposition and a costal perichondrium interpositional graft. His nose was restructured using his own rib cartilage. I placed a single midline tall spreader graft, a caudal septal extension graft, and lateral crural strut grafts. I left the native perichondrium on the undersurface of the lateral crural strut grafts to enhance proper curvature. His right lateral crural strut graft was slightly longer and more curved than the left lateral crural strut graft. I used platelet-rich fibrin with diced fat to camouflage his dorsum (Kovacevic).

At one year postoperatively, he is doing well with excellent nasal aesthetics. His nasal breathing is better out of his right nostril, and his left nostril is slightly smaller. This difference can be linked back to the less curved and shorter left lateral crural strut graft. Ideally, I would have made the left lateral crural strut graft more curved and as long as the right to create a larger left airway.

Secondary rhinoplasty is very complex, and even small details can affect aesthetic and functional outcomes. I take photos at set points during the operation to allow inspection of key points and to see how certain findings can impact the outcome. Every patient has some imperfections after this type of surgery, as perfection is difficult to attain, if not impossible. This type of critical evaluation of your outcomes is important for improving your outcomes. My patient outcomes have continued to improve, even over the past year, due to critical analysis of my results. 📖

10/02/2025

(⚠️ 9-18) This 60-year-old patient presented after undergoing two prior rhinoplasties. She presented with a deviated nose, characterized by an amorphous tip, and nasal obstruction. She requested correction of her deviation, improvement of her tip definition, and correction of her nasal obstruction.

Despite being 60 years of age, her costal cartilage was more than adequate. I harvested her seventh rib with attached native perichondrium to protect the cartilage and allow adequate vascularization. I used a caudal septal replacement graft, lateral crural replacement grafts, and lateral crural extension grafts. I kept the native perichondrium attached to the caudal septal replacement graft and on the undersurface of the lateral crural strut grafts. I also used tall spreader grafts to raise and narrow her nasal dorsum. These grafts also allowed me to straighten her nose.

Three to four months postoperatively, she presented with nasal tip swelling and tenderness that persisted. I performed an endoscopic exam and noted a trapped hair follicle that was causing a low-grade infection. Once the trapped follicle was removed, her low-grade infection cleared. She has done well since and is one year postoperative with excellent nasal function.

Despite her smoldering, low-grade infection, her cartilage grafts have maintained their structural integrity, as evidenced by her preservation of tip projection and lateral wall support. This is likely due in part to the native perichondrium left on her cartilage grafts.
In my experience, most patients aged 50 to 75 have harvestable cartilage that can be used for cartilage grafting. It is essential to maintain the native perichondrium attached to the grafts to protect the grafts and facilitate adequate vascularization. With no attached perichondrium, there is no biological interface to allow nutrients to reach the grafts, and infection can damage the grafts. With perichondrium, the cartilage can survive and heal at the surgical site, preventing resorption over time. Cadaver rib of any kind does not have perichondrium attached because of potential antigenicity. This is one of the most significant disadvantages of using donor rib, which can lead to potential resorption and infection.

All of these techniques are covered in my three-volume textbook "Structure Rhinoplasty: Lessons Learned in Thirty Years," and the newest updates are noted in the new two-volume "Structural Preservation Rhinoplasty" textbook available at the Quality Medical Publishing website.

09/25/2025

(⚠️9-14) This patient presented after undergoing three prior rhinoplasties. She noted that her nose had become progressively larger and less defined with each surgery. She presented with very thick skin and rosacea-like changes to her skin. Patients with thick skin can be very problematic with excessive postoperative swelling and scar formation, creating a poorly defined nose.
In conjunction with a dermatologist, Rania Agha , we have been treating rhinoplasty patients with thick skin with Dupilumab (Dupixant). The study’s results were presented at the Annual Meeting in Los Angeles, California, this past weekend. We have observed a marked improvement in postoperative healing, characterized by reduced swelling and inflammation after surgery. Patients who failed in prior surgeries are doing much better after being treated with Dupilumab. The patients are treated on a program that starts with a preoperative Dupilumab loading dose.
At the time of surgery, it was noted that she had dense scarring and thickening of her tip structure and skin envelope. For the reconstruction, the patient’s own costal cartilage was used to create a sound nasal structure using a caudal septal extension graft, lateral crural replacement grafts, and lateral crural strut grafts. At the end of the surgery, Doxycycline rhinodesis is used (Kovacevic), dead space suturing (Zholtikov) (See yellow circles), and Kenalog 10 mg/ml intradermal steroid injections. I place antibiotic irrigation catheters for five days, and patients go for at least seven ninety-minute hyperbaric oxygen treatments. The patients go on a strict anti-inflammatory diet for one month after surgery and tape their nose at night….continued in comments ⬇️

09/24/2025

I was pleased to give the Gene Tardy Scholar Lecture at the Annual Fall meeting in Los Angeles, CA., this past weekend. 🌴
The meeting was outstanding, and I would like to congratulate the organizing committee, the AAFPRS staff, and Ada Phillips for putting on such an exceptional meeting.
I also delivered two keynote presentations: “Secondary Rhinoplasty: Pushing the Envelope” and “Preservation Rhinoplasty by a Structural Rhinoplasty Surgeon.” I also participated in a panel on and moderated a panel on , which provided valuable information to the audience. My Gene Tardy scholar lecture was on “The Inflammation Connection: Diet’s role in health and aging.” I typically give presentations on and functional . In this case, I had the opportunity to speak on something that I am also passionate about, the anti-inflammatory diet. 🍵
I put all of my patients on the anti-inflammatory diet for one month after surgery. I believe this helps the patients with less swelling and redness after surgery. I discussed how ceremonial-grade matcha can help decrease inflammation and slow down the aging process. I have also been on the myself for over thirty years.
I was also pleased to participate in novel research with dermatologist Dr. Rania Agha, , involving the use of Dupixent (Dupilumab) in rhinoplasty. Dr. Agha presented our research at the meeting. We demonstrated statistical improvement in healing, characterized by reduced postoperative swelling and inflammation, in patients treated with before and after rhinoplasty surgery. Data included pre- and postoperative NOSE and SCHNOS scores, as well as pre- and postoperative ultrasounds. This is important research that can help patients with thick, inflamed skin improve healing after rhinoplasty. 👏🏼

09/18/2025

(⚠️ 8-16) This forty-eight-year-old patient initially presented for revision rhinoplasty in 2002. I performed a on her using her ear cartilage and placed a columellar strut and shield graft.
She did well over the first year but returned years later with a visible tip graft. The skin contracted over her nasal tip, revealing the shield graft. I performed a revision rhinoplasty on her in 2012 using her rib cartilage, a caudal septal extension graft, and lateral crural strut grafts with repositioning (essentially the technique I presently use to this day).
She has done well over the years with a natural-looking nose and excellent nasal function. She came back to ask about a small skin lesion on the nose that I shaved in the office.

This case illustrates how I have refined my techniques over the years to improve outcomes and enhance nasal function. I still use shield tip grafts, but primarily in ethnic patients with thick skin that need tip projection. Additionally, I always camouflage shield grafts to help prevent visibility. I rarely use shield-tip grafts in patients with thin skin due to the risk of graft visibility.
Back in 2002, I was still using ear cartilage and shield grafts in revision patients. This patient was a “watershed” patient who significantly impacted the way I perform rhinoplasty. I had been using lateral crural strut grafts, but started using them more frequently. My and outcomes improved and represent the technique I still use today. Obviously, many additional changes have been instituted over the years, such as moving away from using ear cartilage to using almost exclusively autologous costal cartilage.

Long-term follow-up of your patients is crucial to determine the effectiveness of your techniques. In the case of shield tip grafts, they are effective but must be used in particular patients to get the best outcomes. I learn a great deal from the long-term follow-up. I am even better now than I was a year ago, thanks to the changes I’ve made in my techniques. Frequently, we must reflect on our techniques and approach to rhinoplasty and make adjustments to improve outcomes.

09/10/2025

(⚠️ 9-15)
This 18-year-old patient presented after undergoing prior rhinoplasty that resulted in deformity and nasal obstruction. She had an amorphous tip and dorsal irregularities. A segment of the seventh rib was harvested via a 1.2 cm incision. Spreader grafts were placed to reconstruct her dorsum and middle vault. The lateral crura were deformed requiring lateral crural replacement grafts and lateral crural strut grafts.

She has done well over the past ten years with improved aesthetics and excellent nasal function. ✨

The nasal tip technique used in this patient is very similar to what I presently use for nasal tip reconstruction. This is a time-tested technique that has worked well over the past thirty years. Improvements have been made in other aspects of the operation, including the use of platelet-rich fibrin with diced fat (.miloskovacevic) for dorsal camouflage in thin skin patients, integration of tall spreader grafts, and use of postoperative hyperbaric oxygen treatments in all revisions. These, along with other changes, have improved my patients’ outcomes.

Long-term follow-up is crucial for assessing the efficacy of rhinoplasty techniques. I follow my patient’s long-term; allowing me to assess how my techniques are working. I can improve my outcomes year after year by following patients and making adjustments to my technique based on their results. The evolution of my techniques has enabled me to achieve more consistent results in both function and aesthetics, as noted in my three-volume textbook, “Structure Rhinoplasty: Lessons Learned in 30 years.” The most recent updates to my techniques are featured in the new two-volume textbook, “Structural Preservation Rhinoplasty,” which is available for preorder on the website.

If you do not follow your patient’s long-term, you may not be getting the full picture on how your patients are doing.

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60 E Delaware Place Ste 1425
Chicago, IL
60611

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Monday	9am - 5pm
Tuesday	9am - 5pm
Wednesday	9am - 5pm
Thursday	9am - 5pm
Friday	9am - 5pm

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+13127413202

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http://www.toriumifacialplastics.com/

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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