Nasal tip derotation - use of septal extension graft to lift the tip - short nose

Question

I have had a Rhinoplasty to reduce nasal hump and get tip refinement. However, my nose has been lifted and looks short on my face. The front is the worst as it has increased philtrum length and ugly nostril show. My tip looks artificial and my nose looks short. I am almost 5 months post op. Knowing that it's still early yet I would like to hear if my tip can be de rotated and something close to ny birth nose can be achieved from both front and profile. I have septal extension graft in tip.

Eric M. Joseph, MD · Answer

Based on your two before and after photos, I'm not sure for the surgical intervention is warranted. Additionally, you are only 5 months post-operative. I would wait a full year since you will see some changes in the tip of your nose, and you may end up becoming satisfied with how your nose looks with time.

Richard G. Reish, MD, FACS · Answer

Hello and thank you for your question. After waiting more time, based on your photographs, you may benefit from a revision with tip derotation. In order to perform tip derotation, all scar tissue needs to be released and extended spreader grafts can be placed to derotate the tip. With good surgical technique, you could have an outstanding result. I recommend that you seek consultation with a qualified board-certified rhinoplasty surgeon who can evaluate you in person.

Best wishes and good luck.

Richard G. Reish, M.D.
Harvard-trained plastic surgeon

Best wishes and good luck.

Richard G. Reish, M.D.
Harvard-trained plastic surgeon

Sean Fisher, MD · Answer

Given that you are 5 months post-op, I recommend that patients wait until they are 1 year out to allow for adequate healing and to see final results before considering revisionary surgery. If you are unhappy with your results after adequate healing, a revision rhinoplasty could address your tip rotation and position on your profile view, however it is less likely to return your nose to pre-surgical appearance on frontal view. This is because in increasing tip refinement and correcting a bulbous tip (pre-operative) the lower lateral cartilages are often partially resected and repositioning.
Sean M Fisher MD

Nasal tip derotation - use of septal extension graft to lift the tip - short nose

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