Do dorsal onlay grafts help with borderline piggy noses?

Question

I was left with a short upturned nose and have been looking for before and after pictures of people with my problem (really hard to find!) I can only find patients with saddle nose deformity and notice how augmenting their dorsum kind of seems to push the tip of the nose down. Do dorsal onlay grafts help with borderline piggy noses?

Jamil Ahmad, MD · Answer

Dorsal onlay grafts are typically used to increase the height of the dorsum (dorsal augmentation) or smooth out the dorsum. In your case, it sounds like you have a short nose and overrotation of the tip allowing for excess nostril show. If this is the case, you may require techniques that derotate the nasal tip and lengthen the nose (e.g., caudal septal extension graft, extended spreader grafts). Additionally, you may also need techniques that lower the nostril rims (e.g., lateral crural strut grafts, alar contour grafts). You would probably find it beneficial to consult with a board certified plastic surgeon that performs rhinoplasty frequently to discuss your concerns and possible options to address them.

John Nguyen, MD, FACS · Answer

A dorsal onlay graft alone would unlikely resolve the upturned nasal tip.  There will likely be need for caudal septal work and possible revision work on the lower lateral cartilages.  A consult with a local plastic surgeon that performs rhinoplasties will be your best option.  Good luck and be safe.John T. Nguyen, MD, FACS, FICSDouble Board Certified Plastic Surgeon

Thomas E. Kaniff, MD, FACS · Answer

Dorsal onlay grafts can be placed on top of the nasal bridge to build it up. A stronger looking bridge will make the nasal tip look less up-turned. The grafts are usually cartilage take from the nasal septum and occasionally from another location depending on the need. The most important step is analyzing the nose and developing an appropriate treatment plan.  You should consult with a surgeon experienced in rhinoplasty.  Good luck,Dr. Kaniff

Toby Mayer, MD · Answer

The piggy nose - dorsal onlay grafts do not help. You would need a graft to extend both the central portion of your nose as well as the  AL AE. See a very experienced rhinoplasty surgeon for this as this needs the same expertise as a revision rhinoplasty. You will be able to find examples of this on my website under revision rhinoplasty.

Steven Wallach, MD · Answer

Over rotated tips can be difficult to treat.  Grafts can be used to rotate the tip down a bit to derotate it.

Do dorsal onlay grafts help with borderline piggy noses?

Answers (8)

Answer: The piggy nose - dorsal onlay grafts do not help.

Answer: The piggy nose - dorsal onlay grafts do not help.

Answer: Over-elevated tip

Answer: Over-elevated tip

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Do dorsal onlay grafts help with borderline piggy noses?

Answers (8)

Answer: The piggy nose - dorsal onlay grafts do not help.

Answer: The piggy nose - dorsal onlay grafts do not help.

Answer: Over-elevated tip

Answer: Over-elevated tip

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Recommended reading

Everything you need to know about Rhinoplasty

Our mission is to create a world where every investment in modern beauty is Worth It.