During my rhinoplasty 5 years ago my nasal spine was removed without my previous knowledge. My nose looks much shorter from the frontal view and as a result is not aestetically pleasing. Also, my upper lip now appears too long. I was wondering if there is a procedure that can replace the nasal spine and make my nose appear longer from the front view again? Also, will this procedure, if it exists, make the upper lip appear shorter?
Replacing a Removed Nasal Spine
Doctor Answers (13)
Replacing Nasal Spine
It sounds like you may need a caudal septal extension graft to lengthen your nose and de-rotate the tip. The area of spine removal can be augmented with a cartilage graft.
The nasal spine may be addressed in about 5 % of rhinoplasties
I have published a number of articles on the nasal spine in rhinoplasty and have found that removing all or part of the spine is used in about 1/20 patients. If other nasal tip supports are left in place, treating the nasal spine would have a minimal effect. To fully understand how to restore the proper angle to the nose, called the naso-labial angle, you should see a rhinoplasty specialist.
Fixes for the short nose
Almost everything that can be taken out of the nose during rhinoplasty surgery, can also be replaced in the subsequent revision rhinoplasty. That includes the nasal septal spine and the end of the septum (caudal septum). Many times to rebuild such a nose, cartilage from other areas (ear, rib) are harvested and used as building blocks. So yes, a good revision rhinoplasty surgeon can probably repair your nose. All the best, Dr. Vartanian.
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Columellar/Nasal Spine Revision After Rhinoplasty
Removing the anterior nasal spine usually results in a retracted columellar base. This may make the nose look shorter by closing the nasolabial angle in profile view. This may or may not make the lip look longer however. As part of the nasal spine removal you may have lost the caudal end of the septum as well. The nasolabial angle can be opened up and supported by a cartilage caudal extension graft or even a modified premaxillary implant.
Caudal Extension Graft to Lengthen the Nose
Generally speaking, what you are describing is that your nose is too short and you want to lengthen it. One techniuqe used to do this is called a caudal extension graft or a septal extension graft. Cartilage from your nose or other parts of your body is used to replace the missing portion of cartilage that was removed in the past. However, the maxillary spine is a different issue and is just one part of the caudal septum.
It is in your best interest to consult with a revision rhinoplasty specialist in order to ascertain what your needs may be. It is easy to get lost in the nomenclature of different techniuques, but there is no cookbook way to achieve excellent revision rhinoplasty results. A surgeon that is proficient in revision rhinoplasty will help you navigate these waters.
Replacing the nasal spine.
Nasal spine removal and its affect on the nasal appearance.
The nasal spine is a extension of maxillary bones in the midline just at upper limit of upper lip between the two nostrils. It is where the inferior most segment of the nose sits. Therefore, it supports the lower part of the nose and affects nasal projection, how far the tip looks up or down i.e. nasolabial angle. If nasal spine is removed, then the nasolabial angle is reduced and nasal tip drops. This is used to bring the tip down. As tip is brought down, the lip should appear shorter. The reverse is true for noses that have reduced nasolabial angle, where nasal spine area is augmented with cartilage or implants to push the tip up. This will lead to longer appearing lip. Therefore, in your case, if the nasal spine was removed, the lip should not appear longer. Recommend, to consult an experienced revision rhinoplasty surgeons to first diagnose the problem then correct the deformity as you both feel needed.
Correcting nasal spine removal
Having the nasal spine removed can cause the columella in that area to retract. This can cause the upper lip to appear longer.
Using cartilage grafting techniques, it is possible to correct this problem. I'd recommend visiting with someone experienced in rhinoplasty and revision rhinoplasty to see what your options are.
Nasal Spine Removal During Rhinoplasty
It is difficult to answer your question without photos and examination. However, I agree with some of the comments what you are describing may be a short nose (pig nose). The best way to lengthen the nose is with extension grafts placed inside the nose to de-rotate the nasal tip. If you have septal cartilage left, then your surgeon can use the cartilage. If inadequate septal cartilage is available, other sources of cartilage or even synthetic material (such as medpor) may be considered.
Best of Luck.
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.