Do I need septum lengthening? (Photo)

I agree with Dr. Portuese. You do not need to length your septal cartilage, you need to reduce the small hump on the bridge of the nose, reduce the hanging columella and the alar retraction. You will need some cartilage grafts to stabilize the cartilage framework and the grafts will be harvested from the septal cartilage.

Hi Emc.  Please understand that the definitive answer rests with an in-person consultation and examination.  Upon reviewing your photos, you appear to have excessive columellar show.  Your tip may also be over-rotated.  Grafting is required; however typically septal extension is not used to address columellar show.  If you like, please reference the article below on Nasal Analysis.  There are useful diagrams that may help guide your decision making process.Hope this is helpful.Best wishes.Dr. Shah

You need tip lengthening and derogation. This will require multiple cartilage grafts in the tip and nostril rim area to achieve these changes, one of which would be a septal lengthening graft.

 The photographs demonstrate  excess columellar show and a dorsal hump, both of which can be addressed with a closed rhinoplasty approach as an outpatient surgical procedure. Patients who have a columellar show do not need septal extension grafts

A cartilage graft attached to your septum will be needed to lengthen your nose and decrease tip rotation. Grafts will also be needed to lower your retracted nostril rims.