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

(⚠️10-18) This 18-year-old patient presented with nasomaxillary hypoplasia (Binder’s Syndrome). This involves a deficien...
12/24/2025

(⚠️10-18) This 18-year-old patient presented with nasomaxillary hypoplasia (Binder’s Syndrome). This involves a deficiency in the bones around the base of the nose, requiring major augmentation. In this case, I used a large segment of her 7th rib, incorporating both cartilage and bone. I used the piezotome to remove the large rib segment. I fashioned a bone/cartilage premaxillary graft with a notch to fit over her premaxilla and also to allow integration with a larger caudal septal extension graft. This two-graft combination augmented her maxilla and significantly projected her nasal base and tip. I also performed lateral crural release with lateral crural strut grafts to allow maximal shaping of the nasal tip and to provide strong lateral wall support. The patient is now 2 years postoperatively, with excellent nasal function and much improved nasofacial relationships.

This case illustrates the importance of understanding the impact of augmenting deficient skeletal landmarks to maximally correct congenital deformities. These principles also apply to the management of the cleft nasal deformity. Use of the patients’ own rib cartilage is critical to ensure a lifelong correction that will persist as the patient ages.

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 website. The video of this patient’s case is available via the video stream link included with the purchase of this book. (18)

🙏🏼These cases are what make rhinoplasty such a gratifying operation to perform, as they enable the surgeon to achieve dramatic improvements in patients’ noses. I feel blessed to be able to change patients’ lives with the skills that God has given me on this day before Christmas. Merry Christmas and Happy Holidays to all. 🎄🎄🎄

This patient presented for rhinoplasty and closure of her septal perforation. She underwent two prior rhinoplasties and ...
12/19/2025

This patient presented for rhinoplasty and closure of her septal perforation. She underwent two prior rhinoplasties and developed a septal perforation after the latest surgery. She had a relatively large septal perforation measuring over 2 cm in diameter. She had symptoms of crusting, nasal obstruction, and nosebleeds. She also had a foul smell in her nose.
Her reconstruction required harvesting her own rib and costal perichondrium, as well as nanofat. For larger septal perforations, I raise bilateral pedicled septal flaps to rotate into the perforation and then place a costal perichondrium interpositional graft with thin costal cartilage between two pieces of the perichondrium. I placed a costal cartilage caudal septal replacement graft, lateral crural strut grafts, and tall spreader grafts. I harvested fat from the periumbilical area and processed it into nanofat. The nanofat was injected into the perichondrial interpositional graft, and then it was placed between the septal flaps.

I placed a Silastic healing chamber over the septal perforation closure. Their special type of Silastic sheeting with Silon helped speed mucosalization over the interpositional graft. The septal splints were left in place for two months to allow for complete healing over the graft. The septal perforation was successfully closed with excellent nasal function. Her nasal esthetics were improved as well.

In this case, the septal perforation was due to prior surgery. Damage or thinning of the septal flap can result in this problem. She was having symptoms from the perforation, which necessitated closure. In this case, the combined use of pedicled septal flaps, injections of nanofat around the transpositional flaps, and hyperbaric oxygen therapy enabled successful closure of the septal perforation. This patient underwent ten 90-minute sessions at 100% oxygen and 2.2 atm pressure.

Healing of septal perforations can be complex, as the periphery of the perforation can be atrophic, making the actual size of the perforation larger. In some cases, we will not attempt closure if the area surrounding the perforation is atrophic, as the likelihood of successful closure is lower. The Silastic healing chamber helps to promote healing and improve nasal function. Septal perforations can cause crusting, nose bleeds, obstruction, and bad nasal smells. If possible, I try to close septal perforations less than 2 cm. The combination of a costal perichondrium interpositional graft with a thin rib graft and nanofat, along with postoperative HBO, can help maximize healing. The thin sliver of costal cartilage between the two sheets of perichondium helps to prevent late reperforation. I frequently close septal perforations at the same time as secondary rhinoplasty reconstruction.

These techniques are discussed in a paper I published on using costal perichondrium for perforation closure and also in my three-volume textbook, entitled, "Structure Rhinoplasty: Lessons Learned in Thirty Years." These methods are also covered in the two-volume textbook, Structural Preservation Rhinoplasty, that was just released by Quality Medical Publishing.

We are gathering in Bogotá Colombia to teach at the Face and Nos e Institute Curso Rinoplastia. , and have done a gre...
12/05/2025

We are gathering in Bogotá Colombia to teach at the Face and Nos e Institute Curso Rinoplastia. , and have done a great job with the organization of the meeting. 💥✨

I was able to give Keynote Addresses on Structural Preservation Rhinoplasty and Secondary Rhinoplasty. I was joined by other world class faculty and a very interested group of participants. The meeting will finish tomorrow with a fresh cadaver lab. Last night we enjoyed a lively night at Andres D.C. Bogota.
The theme of the meeting was D.C. League of Superheroes, or in this case “The Rhinoplasty League.” 💫💫💫

We are gathering in Bogotá Colombia to teach at the Face and Nos e Institute Curso Rinoplastia. , and have done a grea...
12/05/2025

We are gathering in Bogotá Colombia to teach at the Face and Nos e Institute Curso Rinoplastia. , and have done a great job with the organization of the meeting. 💥✨

I was able to give Keynote Addresses on Structural Preservation Rhinoplasty and Secondary Rhinoplasty. I was joined by other world class faculty and a very interested group of participants. The meeting will finish tomorrow with a fresh cadaver lab. Last night we enjoyed a lively night at Andres D.C. Bogota.
The theme of the meeting was D.C. League of Superheroes, or in this case “The Rhinoplasty League.” 💫💫💫

(⚠️10-14) This patient presented after undergoing two prior failed rhinoplasties. She also had severe nasal obstruction ...
11/26/2025

(⚠️10-14) This patient presented after undergoing two prior failed rhinoplasties. She also had severe nasal obstruction and extremely thick, sebaceous skin. Examination of her nose revealed an amorphous tip and inadequate tip projection. To manage her thick, sebaceous skin, we treated her with Dupilumab (Dupixent, ).
Her reconstruction involved using her own rib cartilage with a caudal septal extension graft, tall spreader grafts, lateral crural replacement grafts, and lateral crural strut grafts. I injected her thick skin with intradermal Kenalog (10 mg/ml) in the tip and supratip at the end of the surgery. Postoperatively, she was placed on an anti-inflammatory diet, and she went for daily hyperbaric oxygen treatments.
When her cast was removed on postoperative day 7, her nose looked good despite her thick skin. Her nose continued to improve over time with continued Kenalog injections and periodic Dupilumab injections. Postoperative ultrasound exams revealed a thinner tip and supratip skin. She is doing very well with excellent nasal function ten months after her surgery, and both aesthetics and function continue to improve. 👏🏼
CONTINUED IN COMMENTS ⬇️⬇️

Working with Marina Medical, we were able to complete the third , ‘The Course’ in Fort Lauderdale, Florida. 🌴The meeting...
11/19/2025

Working with Marina Medical, we were able to complete the third , ‘The Course’ in Fort Lauderdale, Florida. 🌴

The meeting was a resounding success with very positive feedback from the participants. We were maxed out on the space with all stations filled and a packed lecture hall. Each participant had the opportunity to view presentations, dissections, and one-on-one teaching by some of the world’s best preservation rhinoplasty surgeons.

The faculty went from table to table to teach the students how to execute the preservation techniques. The unique aspect of this course is that each participant and partner dissects at a station with a new head each morning. The first day was high strip with anatomy and bony work. The second day was endonasal polygon tip with intermediate-level flaps (Tetris and subdorsal Z-flap) and surface work, and the last day was devoted to low-strip SPQR with more bony work. The course covered each technique in depth over the three days. Each participant essentially performed the operations on the heads at their stations. The faculty was fantastic and very helpful to the participants.

The Marina Medical staff was outstanding and executed the meeting to perfection. Thank you, Jeff, Alex, Enrico, Gabiel, and the rest of the crew. Thank you, Ezra, for the excellent AV work. Your hard work was responsible for the course’s success. 👑

Thank you to the sponsors, QMP, Acteon, W and H Med, Bilumix, Hanson, Facial Plastic Surgery & Aesthetic Medicine journal and of course, our hosts, Marina Medical.

Special thanks to the world-class faculty and my co-director, Aaron Kosins, who helped edit the newly released two-volume Structural Preservation Rhinoplasty book that was introduced at the meeting this past weekend. Great work, Andrew, Amy, Mason, Carol, and Carolyn. The books look fantastic and available at the QMP website.

I would also like to thank the participants who demonstrated determination to help one another and an intense desire to learn everything possible about preservation rhinoplasty. Good luck with your use of preservation rhinoplasty in your practices.🥂

(⚠️9-17)This 26-year-old patient presented after undergoing prior rhinoplasty. She suffered an infection postoperatively...
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.

This 38-year-old patient presented after undergoing two prior rhinoplasties. She has thin skin that contracted after her...
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.

(⚠️ 8-12) This 26-year-old patient presented for secondary rhinoplasty after undergoing one prior rhinoplasty. She had a...
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.

🔊🔊🔊🔊The Marina Medical Cadaver Dissection Meeting, “The Course,” is less than one month away. A group of the top rhinopl...
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.

(⚠️ 10-16) This patient presented with nasal deformity and nasal obstruction requiring nasal reconstruction using her ow...
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.

I had a great experience going back to Morelia, Mexico, for the 46th Congress. I saw many friends I hadn’t seen in year...
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

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60611

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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