Would like to downturn and lengthen my nose, is this possible with filler?

Lengthening a short nose: short noses are extremely challenging. The only way to achieve a small amount of lengthening, if any, is by adding a caudal extension to the septum. This is harvested from the septum and then sutured to the bottom of the septum in an attempt to add length. A lot depends on the flexibility of the skin and other tissues of your nose, And usually only a millimeter or two of lengthening can be achieved if any. Deprojecting an overly projecting short nose will help the appearance as well. Also derotating the tip slightly more downward can reduce the appearance of a short nose . if the dorsal profile is scooped or concave this will make a short nose look even shorter, and filling in the dorsum and giving it a slight convexity may make a short nose look less short. This is one of the most challenging problems in Rhinoplasty and the results can be quite variable and in some cases disappointing.

Hello and thank you for your question. You have an extremely difficult problem to fix! It sounds like your biggest concern is your foreshortened nose and over-rotated and possibly over-projected tip, as you mentioned. To fix these issues, you would need to lengthen, deproject, and rotate the nasal tip- and as you've already seen, the strength needed to do this is not possible with fillers. The only way to properly address your issue is with rhinoplasty surgery- actually, addressing the shape of the nose (particularly the tip) is one of the most common reasons people undergo a rhinoplasty surgery.

In addition to addressing your aesthetic concerns, your septal cartilage (or an off-the-shelf alternative) would be harvested (removed) and turned into multiple cartilage grafts, which would then be secured into different areas of your nose for structural support, including in the columella (middle bottom portion of your nose between your nostrils) to really reinforce the tip and alae in the new shape. You would need all this to both lengthen and deproject your nose, as well as adjust the rotation, and really hold everything in the new position.

The open approach is very effective in facilitating complex, precise maneuvers to refine the nasal shape and size to a particular aesthetic and look. Rhinoplasty is arguably the most difficult procedure to perform in all of plastic surgery. I would only recommend going to see a surgeon who feels very comfortable with both primary and revision rhinoplasty procedures, and who has significant training and experience in these types of surgeries. This is a surgery of millimeters, so if the surgeon you're going to only does 1-2 per month, you are not going to get the best result possible.

Of course it is always difficult to provide tentative surgical recommendations, as there is only so much information to be gained from the photos and description provided.

Dr. Donald Groves, our expert facial plastic surgeon, has extensive training and experience with complex rhinoplasty surgeries, so I’d recommend for you to come see him (or another plastic surgeon who is extremely comfortable with rhinoplasties) for a formal consultation to thoroughly discuss your surgical goals, undergo a formal examination, evaluate all your options (surgical and nonsurgical), and decide on the best procedure(s) and type of anesthesia for your specific case. I hope this helps!

Dr. Emer

Generally, I do not believe that fillers can significantly raise or lower somebody's nasal tip appearance. That said, depending on your examination, artful placement of fillers may lead to improved contours. Thank you for your question. Sincerely, Dr. Joseph