My tip is shifted to the left and my left nostril is very retracted. I have been told by my doctor that once he fixes the tip the nostrils will be fixed automatically. I also want to know if counter rotating the tip makes the distance between the upper lip and the nose smaller. Thanks
Can a Crooked Tip Creates a Retracted Nostrils?
Doctor Answers (7)
Crooked nasal tip and retracted nostrils
A twisted tip will create asymmetrical nostrils, but not necessarily alar retraction. The tip cartilages can be made more symmetrical with dome binding sutures, but is unlikely to repair alar retraction. Alar retraction is best treated with a composite graft of both cartilage and skin harvested from the ear. When the tip has been adjusted, distance between the upper lip and nose will appear smaller since the tip will be deprojected.
There are many ways to fix a crooked tip
Retracted nostrils usually are a result of a prior rhinoplasty operation. Previous surgery, especially if done 20+ years ago, often leaves the tip or lower lateral cartilages with a variety of deformities. Previous surgery on the nasal tip emphasized excision of cartilage to provide refinement. We know, as a result of following these patients for many years, that such techniques result in piching, bossae (knobs of cartilage on the dome or tip), and alar retraction. To correct such problems we must, as rhinoplasty surgeons, be aware of how to stucturally rebuild the nose to provide a solid foundation for the tip. This is done through grafting. To correct your short nose deformity you can expect a variety of grafts (either from the septum, ear or rib) to be placed in your nose. Lateral crural strut grafts, extended spreader grafts and caudal septal extension grafts have worked well in my practice to lower the tip and provide a better lip-tip aesthetic. Hope this helps!!
Will an Asymmetrical Tip Cause Nostril Retraction?
It is possible to fix a retracted nostril by correcting the tip asymmetry, but pictures are necessary to answer your question accurately. Technically the distance between the lip and the nose (ie. the length of the upper lip) is determined by the space between the pink skin of the lip and the columella at the base of the nose. Tip rotation will not change that distance.
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Rhinoplasty and tip issues
Without an exam, it is impossible to say whether or not the retracted nostril will be corrected with tip revision.
Can a Crooked Tip Creates a Retracted Nostrils?
The shape, of the nostrils and how similar they appear is determined by the size, shape and strength of the lower lateral cartilages of the nose that comprise the nasal tip. These can be modified during closed or open Rhinoplasty to varying degrees. Tip rotation is what increases or decreases the appearance of upper lip to nose distance. Be sure the Rhinoplasty Surgeon, you choose, understands and follows the proper aesthetics of facial (and nasal) beauty for the creation of a naturally, more attractive nose and face.
It is possible to rotate your nasal tip to improve symmetry. You would need to provide photos to determine if it would be appropriate.
Correction of a crooked tip and retracted nostril with revision rhinoplasty
Your tip deviation to the left and retraction of the left nostril are very likely related to the same issue, that your left tip cartilage (lower lateral cartilage) is flimsy and weak. This can be related to trauma but most often results from a prior rhinoplasty in which too much of this cartilage is shaved, leading to a loss of support. You can also get pinching on this side, which can cause difficulty breathing. In some cases, insurance coverage may be appropriate.
Basically, the solution to these problems is to replace the structural integrity of this tip cartilage, which can be achieved with placement of a lateral crural strut graft. This is a strong and straight piece of cartilage which is stitched in place underneath the existing cartilage. This graft can be placed such that it pushes the nostril rim down and the tip back to the right. This cartilage is ideally taken from the septum. If the nostril is still retracted, a thin piece of cartilage (rim graft) can be placed just inside the nostril rim, in front of the cartilage. In cases of severe retraction, a composite graft of skin and cartilage can be taken from the ear and placed along the rim, pushing it down further.
Counter-rotating the tip means that the angle between the upper lip and tip is reduced. This is the opposite of rotation, in which the tip is lifted up and this angle is increased. During your revision rhinoplasty consultation, computer imaging can be very helpful in discussing with your surgeon where you would like your tip positioned.
These answers are for educational purposes and should not be relied upon as a substitute for medical advice you may receive from your physician. If you have a medical emergency, please call 911. These answers do not constitute or initiate a patient/doctor relationship.