Even though all surgeons have their own way of doing a Rhinoplasty there are a number of steps common to most methods.
exposure of the skeleton of the nose: the surgeon begins by exposing the underlying skeleton of bone and cartilage. This is done by separating these structures from the overlying skin. The incision is placed either inside the nose (closed technique) or partly on the outside (open technique).
septal surgery: the strip of cartilage which separates the two sides of the nose is called the septum. It is sometimes bent and interferes with breathing. If so it may need to be straightened. If it is too long it is often shortened.
shaping the profile: many patients complain of a hump on the bridge (dorsum) of the nose. This is usually made of both bone and cartilage. It is removed with scissors or a saw. When the nose is flat the profile may be augmented with grafts of bone or cartilage.
refining the tip: if the tip is large or boxy much of the tip cartilage can be removed or reshaped to refine the shape.
narrowing the nasal bones: if the bridge of the nose is wide the surgeon will narrow it by fracturing the bone on each side and moving it closer to the center.
reducing nostril flare: if the nostrils are flared they can be reduced by removing a small wedge of tissue from the base of the nose (alar wedge).