Rhinoplastic surgeons continue to seek technical refinements that will result in a consistently reliable postoperative outcome. Over the past 25 years there has been a steady progression away from the simple Joseph reductive rhinoplasty technique toward the use of various grafts to improve both the functional outcomes and aesthetic end result of this procedure. The original reductive template continues to be a major component of a new conceptual paradigm, which has evolved to incorporate the understanding that structural components must be placed to allow a more precise outcome. Specifically, once the nose is reduced to proportions that correspond to the preoperative analysis, separate grafts and implants are placed to prevent a change in the shape of the nose by the constricting effects of the skin shrink-wrapping around the skeletal framework. This article focuses on the use of implants for structural architecture in the senior author's primary reduction-structured rhinoplasty cases.
