I will be having Rhinoplasty done in December for my upturned nose. What technique do you think would be the best for my nose for a successful outcome? My surgeon said he would be removing some cartilage from the tip of my nose. What sort of result would I get with that? Please see my picture for your reference. Thank you to all who respond.
Best Technique for Upturned Nose Rhinoplasty?
Doctor Answers (8)
That could result in a problem for you.
The photo is with your head down and no front view is shown. It appears that you have a thin skin already up-turned nose. Often when unskilled surgeons "narrow the tip" in the front view, the nose turns up more and would create a surgical appearance which would be worse than what you started with. Discuss this risk with your doctor and seek a second opinion.
Remember sometimes "perfection is the enemy of good".
I am assuming that you had a prior Rhinoplasty. There are several techniques to "derotate the tip." This can include work through an incision placed within your nose to free the soft tissue and tip from the septum (using a transfixion incision), and using sutures to reduce the height and length of the tip.
Sometimes cartilage grafts can be inserted as what are called extended spreader grafts or tobaggon grafts to advance the nose. Sometimes, addding a graft at the base of the septum can help as well. Without a careful exam and review of multiple view photos it is difficult to give you a specific answer.
Seek a second consultation or second opinion
I am interested to know if you have had a rhinoplasty in the past? If the overrotation you are experiencing has occurred from a previous rhinoplasty then I would recommend caution and engage the services of someone comfortable with revisional work. Certainly more photos would provide a clearer picture. But regardless...
Reduction rhinoplasty (removal of more cartilage) from the nasal tip is unlikely to provide derotation. Trimming of cartilage from the anterior septal angle would provide a delicate derotation and in combination with suture fixation of the nasal tip complex to the newly positioned septum would provide the desired result (a reverse tongue in groove technique).
The analogy I would provide is entering a tent and shortening the long supporting tent pole to lower the tent closer to the ground leaving the generic shape the same. That is not an exact analogy depicting the intricacies of the operation, of course.
Always feel comfortable having a second consultation with your surgeon to ensure that the goals and operative plan match your expectations.
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Dropping the nasal tip
Without all photographic views, including the base view (the one from below the nose looking up at the nostrils) I can not give you a specific plan to accomplish your goals. However, several options are present to derotate or drop your tip.
1) shaving the bottom of the septum can sometimes allow the tip to drop. Since it appears you do not need a lot in that regard, this might work well for you and would probably be my choice in your case.
2) trimming the tip cartilages right where they meet your upper lip can also produce derotation.
3) removal of bone near the base of your septum can add additional derotation if desired.
4) formal tip surgery involving sutures can be used to change the overall angulation to your tip. This can be tricky and I would not recommend this unless you need significant narrowing of the tip when viewed from the front.
May options exist and, if your surgeon is experienced in Rhinoplasty, whichever one he or she chooses will be based on their own past experience and success.
Need more photos
It isn't entirely clear from the one photo you have exactly why you are doing anything at all to your nose. It would help all to see a true side view of you from both sides.
Best Technique for an Upturned, Short Nose
During rhinoplasty, an upturned or short nose can be one of the most challenging whether it is primary or secondary. The key element is to choose your Board Certified Rhinoplasty Surgeon wisely as one will have to de-rotate the nose. This can usually be done with patients who need cartilage grafts as a primary rhinoplasty or may need ear or rib cartilage done secondarily. This can be very challenging if it has any other associated problems or syndromes. The results can be truly amazing and quite satisfying, however, this has to be done after careful analysis of the patient’s face and nose.
Most often the solution to an upturned nose is to add a little bit of length to the nose.
Most often the solution to an upturned nose is to add a little bit of length to the nose. Adding a bit of volume to the nasal dorsum will also often help. Both of these things can be accomplished using your own tissue – harvested from the septum or from the cartilage of your ear. Occasionally, it may be more appropriate to use an “alloplastic” material to achieve this, such as silastic or even Gortex™.
Meet with your Surgeon again
Very good advice given to you here.
I agree that it is difficult to give comprehensive advice to you without additional photos or a chance to exam your nose in person.
I also agree that in most cases downward rotation of the nasal tip is best accomplished by removing cartilage from the nasal septum (the rubbery wall between your right and left nasal cavities). Cartilage removal from the tip can be done but is indicated only for select types of anatomy.
Sounds like you still have some questions about your surgery - it would be worthwhile to have another consultation with your Surgeon or have another opinion.
Always best to have all of your questions answered and a clear understanding of your surgery prior to proceeding.
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