Hello, I had rhinoplasty surgery 2 years ago but unfortunately I am unhappy with the result. The tip of my nose has been over-reduced - it is too turned up and under-projected for my liking. It looks small and stubby from front on and from the side there is more nostril show. I would like to know what type of graft could be used to re-project my nose outwards (about 1 to 1.5mm) and downwards to look more like how it used to look? Would a columellar strut be sufficient? Thanks.
What Sort of Graft Would Be Needed to Extend the Tip and Produce This Result? (photo)
Doctor Answers 4
Increasing Tip Projection and Nasal Length
A shield type tip graft or a septal extension graft will be necessary. I need to examine you or at least have full face pictures to be more specific.
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Increasing nasal tip projection
There are several ways to increase tip projection, however you are also interested in counter rotation (turning the tip downwards) so that there isn't as much visibility to your nostrils. Rather than simply adding cartilage grafts on top of the underlying structure to create an improved contour, I prefer to move the actual tip cartilages and create a better foundation and overall anatomy. Grafts that would be used in such a case would be structural in nature and placed deep within the framework so they are not visible under the skin. I would created a slightly longer septum that would allow me to then re position the tip cartilages to create the change you are asking for. Either a caudal septal extension graft or extended spreader grafts would be used. If just a columellar strut were used it would likely create increased nostril show because the columella would extend longer than the alar rims. Additionally, this graft would not counter rotate the tip at all. I prefer not to use shield grafts for this purpose if at all possible as they often become visible over time with the soft tissue contracting and can add bulk to the infratip lobule making the nose look 'beakish'.
Tip projection can be obtained through sutuing technqiues and grafting. An exam in person is essential.
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Revision rhinoplasty for flat nose
To improve the projection of the nose there are a combination of techniques available such as suturing the tip cartilages together, strut grafts, peck grafts, and onlay grafts to the top of the tip. There are also maneuvers that can allow derotation of the tip as well.
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