The trap of "a CT is mandatory" for rhinoplasty? The difference between those who really need it and those for whom it is unnecessary
The online rumor that "precise rhinoplasty always requires a CT" — are you taking it at face value?
What you will learn in this article
- The real reason a CT scan becomes necessary in rhinoplasty
- The decisive difference from cases where a CT scan is unnecessary
- The role of CT in Asian rhinoplasty and revision surgery
"I'm worried that an unnecessary exam will increase the cost and burden..." — we resolve that question based on medical grounds.
Is "a CT scan just in case" wrong for rhinoplasty? The real reason it is needed
Do you think "precise surgery always requires a CT"? In fact, a CT is not mandatory for all rhinoplasty. In an era overflowing with aesthetic-medicine information, it tends to be misunderstood that an exam using the latest equipment is always best, but in reality the necessity of a CT scan changes greatly depending on the patient's condition and the desired surgical content.
The greatest role a CT (computed tomography) scan plays in rhinoplasty is grasping, in three dimensions, the internal structures such as bone and cartilage that cannot be seen from outside. It demonstrates its true value especially when assessing the degree of bend of the nasal septum (the wall separating the left and right spaces of the nose) and the thickness of the internal bone.
An analytical study of CT images on septal deviation conducted by Lin et al. (2014) reports that using CT makes it possible to accurately compare and assess an ideal straight septum and the actual degree of bend. Also, the morphometric study using CT by Buyukertan et al. (2003) suggests that a CT scan is useful for grasping septal deviation three-dimensionally. Thus, when there is a need to accurately grasp complex internal structures, a CT scan may become an important source of information.
So how is it in practice? Even for surgery that simply raises the nose a little, is such a precise exam mandatory?
Asian rhinoplasty and short-nose revision: complex cases where CT is valued
In Asian rhinoplasty, there is a representative kind of case where the importance of a CT scan rises. That is when performing "revision surgery" to fix a deformity caused by past surgery, or "short-nose revision" to lengthen a nose that has become extremely short.
Online it tends to be said simply that "this technique is the best," but the inside of a nose with a past surgical history is not so simple. Kim and Choi (2024) report on revision surgery for multiple surgical histories in Asians and for the contracted nose (a state in which internal scarring has hardened and shrunk, making the nose short and turned upward) caused by silicone prostheses. In the revision of such a contracted nose, it is necessary to stretch the skin back to its original length and rebuild a strong cartilage foundation that can withstand the skin's contractile force.
In revision surgery, it is difficult to predict before surgery how much of which cartilage remains from the previous surgery, and how the scar (the hard tissue of a scar) has adhered. Therefore, to grasp the residual state of internal cartilage and bone and the exact position of prostheses or cartilage inserted in the past, a CT scan can become a very effective means.
Furthermore, a CT scan is also considered when there are functional problems such as nasal congestion (nasal obstruction) or a bent nose. According to a study by Chauhan et al. (2011), 38% of patients wishing for revision rhinoplasty had a "crooked nose" as their chief complaint, and 36% complained of "nasal airway obstruction." Not only for beauty of appearance, but also to improve and maintain the important function of breathing, assessing the state of the nasal septum and the turbinates (the folds within the nasal cavity) with CT may be helpful. In fact, Egeli et al. (2004) reported the usefulness of assessing the inferior turbinate with CT in patients with a deviated septum.
The pitfall hidden in septal extension surgery: the "unexpected site" where CT shines
The factor that most affects satisfaction is not "a CT of the nose." That will be explained later.
Inseptal extensionsurgery, which firmly extends the nasal tip forward or downward, it is common to use one's own septal cartilage or ear cartilage. However, in revision surgery, or in Asians who originally have small cartilage, rib cartilage (the cartilage of the ribs) is sometimes used to secure sufficient strength and volume.
What becomes important here is the unexpected factor mentioned earlier, namely"a chest CT scan."According to a report by Cochran (2016), when harvesting rib cartilage, especially in older patients, "calcification" of the cartilage (the phenomenon in which cartilage hardens and changes to be like bone) becomes an important concern.
If the cartilage is calcified, it becomes difficult to process and use as a nasal foundation, with the risk of being forced to change the plan during surgery. Therefore, Cochran (2016) recommends performing a preoperative chest CT scan (coronal reconstruction images) for patients with a strong suspicion of calcification. In other words, to make rhinoplasty successful, a CT scan can sometimes play a very important role for the purpose of confirming not the nose itself, but the state of the rib cartilage.
Cases where a CT scan is "unnecessary": criteria for avoiding excessive burden
"So, do I need a CT after all?" — that's what you thought, isn't it? The explanation so far conveyed how beneficial a CT scan is in revision surgery and complex surgery using rib cartilage. But conversely,for many general first-time surgeries that do not fall under these, a CT scan is not necessarily needed.
For example, in cases such as a person undergoing nasal surgery for the first time who wants to add a little height to the nasal tip (tip plasty), or who wants to shape the nasal bridge using a prosthesis (augmentation rhinoplasty), sufficient information can be obtained in most cases through the physician's careful inspection and palpation. An experienced specialist can draw up an appropriate surgical plan by directly touching and confirming the size of the cartilage, the thickness of the skin, how easily it stretches, and so on.
The most common question at consultations is this. "Doctor, by about how many millimeters will my nose become higher?" For simulating such a change in appearance and aligning the image with the patient, 3D simulation software and detailed photo analysis are often more intuitive and useful than CT images. To avoid unnecessary radiation exposure and additional cost burden, it is important to discuss thoroughly with your physician whether a CT is really needed for the surgical content you desire.
Achieving both "function and beauty," which governs postoperative satisfaction
To raise postoperative satisfaction, a certain important condition must be met. The satisfaction of rhinoplasty is said to depend greatly not just on "whether the appearance became beautiful" but on the functional aspect of "whether you can breathe comfortably after surgery."
In fact, the survey by Chauhan et al. (2011) revealed that 33% of patients wishing for a first rhinoplasty are concerned not only about appearance worries but also about "nasal congestion." If, in the pursuit of cosmetic improvement, you narrow the internal airway (nasal cavity), the quality of life after surgery may decline.
Therefore, another criterion for judging whether a CT scan is needed lies in the point of "whether a problem with nasal function is lurking." For those who originally have rhinitis or severe nasal congestion, or who are aware that their nose is bent due to a past fracture, it is necessary to combine surgery that corrects the internal curvature (such as septoplasty) at the same time as correcting the appearance. When such a complex approach involving functional improvement is required, a prior CT scan will be a powerful tool that supports safe and reliable surgery.
Conclusion: to discern the choice that is optimal for you
So far, we have explained the difference between cases that warrant a CT scan in rhinoplasty and those that do not. A CT is, after all, just one "tool" for accurately grasping the internal structure; it is not itself a magic wand that guarantees the success of surgery. What matters most ischoosing the appropriate exam and technique to match each patient's nasal condition, past surgical history, and the goal they aim for.
In recent years, you may see extreme opinions on social media and the like, such as "a clinic that doesn't take a CT is dangerous," but from a medical standpoint, that is not necessarily correct. Performing necessary exams appropriately and avoiding unnecessary burden is, one could say, the way of honest medicine that stands by the patient.
If you find yourself thinking, "What about my case?"
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Summary of this article
- A CT scan is not mandatory for all rhinoplasty, and there are many cases, such as first-time surgery, where it is unnecessary
- In the case of revision of a contracted nose (short nose) or a history of multiple surgeries, CT may be effective for grasping the internal structure
- In septal extension surgery using rib cartilage, a chest CT is recommended to confirm calcification of the cartilage
- When functional problems such as nasal congestion or a strongly bent nose are suspected, a CT scan is helpful
If there is anything that concerns you, please feel free to consult us first. At Zetith Beauty Clinic, we provide consultation based on medical grounds.
Author of this article
Hiromitsu Nakamura Physician
Zetith Beauty Clinic Ginza, Osaka, Fukuoka
He has a track record of research presentations at domestic and international academic conferences, and is also engaged in technical guidance and education for Zetith Beauty Clinic as a whole. He specializes in precise rhinoplasty based on anatomical grounds, pursuing natural results tailored to each person's bone structure and tissue.
References
- Suh M, Jin H, Kim J. Computed tomography versus nasal endoscopy for the measurement of the internal nasal valve angle in Asians. Acta Oto-Laryngologica. 2008 (DOI)
- Suh M, Jin H, Kim J. Clinical Values of Computed Tomographic Rhinometry. Acta Oto-Laryngologica. 2008 (DOI)