Deviated septum and over projected nasal tip (Photos)

It’s great that you’re exploring your options in a structured way—understanding both functional and aesthetic aspects is essential before proceeding with any surgical plan.
You mentioned two primary concerns: a deviated septum (confirmed by an ENT) and a sense of nasal overprojection, particularly in the subnasal area where cartilage becomes more visible when the upper lip is flexed. You also raised an important aesthetic point regarding a thin upper lip and the potential for combining a lip lift with rhinoplasty.
Let’s break it down:
1. Septorhinoplasty and ProjectionCorrecting a deviated septum can absolutely be combined with structural refinement of the nose. If the tip appears overprojected or the columella overly exposed, septorhinoplasty allows for cartilage repositioning or reduction to restore better harmony between the nose and upper lip. The subnasal indentation you described may be related to the way your cartilage sits or interacts with the surrounding soft tissue, and this can often be addressed during the same surgery.
2. Lip Lift ConsiderationsA lip lift is sometimes performed alongside rhinoplasty, but certain factors need to be carefully evaluated—especially skin tension and soft tissue balance in the upper lip area. Performing both surgeries simultaneously is possible, but it requires meticulous planning to avoid distortion of either the nasal base or the upper lip shape during healing. Some surgeons prefer staging the procedures, while others may perform them together when anatomically appropriate.
3. Imaging and Surgical PlanningDigital imaging or morph simulations can be helpful in visualizing how nasal refinement and lip lift could work together on your specific facial structure. These tools also help set realistic expectations for how soft tissue contours may shift postoperatively.
Combining a lip lift with septorhinoplasty is a feasible option in the right hands, but careful anatomical assessment and surgical sequencing are key. A board-certified plastic surgeon or facial plastic surgeon experienced in dual procedures can guide you through this process.
Wishing you a clear and well-supported surgical journey

Based on your photos, you are a great candidate for rhinoplasty. The columella can be brought up some, the length of your nose reduced, and the tip refined. Since a fair amount of work will be done in the area of the lip lift incision, I would not do the lip lift at the same time. Let the swelling go down, and then it can done as a local procedure in the office. Be sure to see a rhinoplasty expert for consultation.

Yes, you would benefit from a rhinoplasty. However, you would also benefit from a lip lift. A lip lift does 4 things: shortens the distance between the nose and upper lip, increases the mucosa of the upper lip, increases the incisor show and pulls up the corners.

Best Wishes,

Gary Horndeski, M.D.

You are a great candidate for a subnasal lip lift simultaneous to your rhinoplasty. This will correct this line of demarcation when smiling (or making that facial expression in the photo).

Based on your limited photos, you appear to have very thin nasal skin. This is associated with nostril asymmetry, an over projected tip appearance, and a prominent anterior nasal spine. Goals of functional and cosmetic rhinoplasty surgery may be to provide a less distracting nasal appearance, along with better breathing. Please consider meeting with several reputable rhinoplasty specialists so you can see what to expect after surgery. Thank you for this question. Sincerely, Dr Joseph

Hello and thank you for your question. Based on your photographs, You are a great candidate for rhinoplasty. Maneuvers for your surgery would include tip refinement, nasal tip deprojection, tip elevation, among other maneuvers. 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

Hi,Your Septum seems so long that it effects its front borders,like in your case.The fromtmost part of your Septum pushes its front neighbours kolumella (the skin area between nostrils) and also orbicularis oris (round shaped muscle of the mouth)muscle,especially while facial expressions like smiling.That is why the fold line seen there,the orbicularis oris muscle doesnt have enough area to make its movement as it should be.So not only correcting deviated Septum but also remıving excessive part of the frontmost part is necessary.Also the overgrowth of the anterior nasal spine makes it exaggerated.Lip lifting surgery can be combined with Rhinoplasty surgery if there is enough distance between vermillion line and subnazal region,it can be understood in physical examination.Have a nice day.
Emin Eren,MDAesthetic and Functional Nose Surgery Clinic

Addressing a deviated septum and an over-projected nasal tip often involves two separate but potentially combined surgical procedures: septoplasty and rhinoplasty.

1. Deviated Septum:

A deviated septum is a condition where the nasal septum, the cartilage and bone that divides your nasal cavity into two nostrils, is displaced to one side. This can cause breathing difficulties, nasal congestion, and other issues.
The surgical procedure to correct a deviated septum is called septoplasty.
Septoplasty aims to straighten the nasal septum, allowing for better airflow through the nasal passages.
The procedure is typically done internally through the nostrils, so there is no visible external scarring.
Recovery from septoplasty usually involves some nasal stuffiness and discomfort for a few days to a week. Most people can return to work or school within a few days, but complete healing can take several weeks to a few months. You'll be advised to avoid strenuous activities, blowing your nose forcefully, and potentially lifting heavy objects during the initial recovery period.
2. Over-Projected Nasal Tip:

An over-projected nasal tip means that the tip of your nose protrudes too far forward from your face.
The surgical procedure to reshape the nose, including altering the projection of the nasal tip, is called rhinoplasty.
Rhinoplasty for an over-projected tip (tip deprojection) involves reshaping the cartilage and sometimes the bone in the nasal tip to bring it closer to the face and achieve a more balanced profile.
Rhinoplasty can be performed using an open approach (with a small incision across the columella, the skin between the nostrils) or a closed approach (with incisions only inside the nostrils). The choice depends on the complexity of the changes needed.
Recovery from rhinoplasty involves more swelling and bruising than septoplasty alone, particularly around the nose and eyes. A splint and/or packing may be placed inside and outside the nose for support and protection during the initial healing phase (usually about a week). Significant swelling typically subsides within a few weeks, but subtle swelling can persist for months, and the final refined shape of the nose may not be apparent for up to a year. You'll need to follow specific instructions regarding activity restrictions, head elevation, care of the incision and splint, and avoiding trauma to the nose.
Combined Procedure (Septorhinoplasty):

It is very common and often recommended to address both a deviated septum and cosmetic concerns like an over-projected nasal tip in a single surgical procedure called septorhinoplasty.
Combining the procedures offers several benefits:
Single recovery period: You only go through the recovery process once.
Coordinated results: The surgeon can ensure that the functional correction of the septum complements the aesthetic reshaping of the nose for an overall harmonious outcome.
Efficiency: It reduces the total time spent in surgery and under anesthesia.
Next Steps:

If you are concerned about a deviated septum and an over-projected nasal tip, the best course of action is to:

Consult with a board-certified ENT (Otolaryngologist) or a facial plastic surgeon experienced in both functional nasal surgery (septoplasty) and cosmetic nasal surgery (rhinoplasty).
During your consultation, the surgeon will:
Evaluate your breathing and the structure of your nasal septum.
Assess the projection and overall shape of your nose.
Discuss your symptoms, concerns, and aesthetic goals.
Explain the surgical options, including the techniques involved in septoplasty and rhinoplasty for tip deprojection.
Discuss the risks, benefits, and expected outcomes of the surgery.
Outline the recovery process.
Answer all your questions.

A septoplasty can improve airflow dynamics in the back of your nose by straightening your deviated nasal septum. A cosmetic rhinoplasty can accomplish changing the shape of your nose. A Closed Rhinoplasty approach can accomplish reduction of the projection of your nose, and reducing the hanging columella/nasal spine that is present. A lip lift can accomplish shortening your upper lip as well. Both a closed septoplasty and closed rhinoplasty and lip lift can be combined together under one anesthesia with one recovery. Choose your rhinoplasty specialist wisely based on extensive experience producing natural results.