Can my nose be de-rotated without septal extension graft?

Question

I am one year post op from rhinoplasty. Unfortunately my nose was over-rotated and now looks short and I feel like it does not fit my other features. My doctor used suture techniques and a columellar strut but I am unsure if he has shortened my septum. My doctor likes how my nose is and will not do revision. Would lengthening the nose require firm grafts or could other techniques be used? I am already uncomftortable with the columellar strut and would not like my nose to be harder. Thank you.

Callum Faris, MD · Answer

Thank you for your questions.This is a frequent unwanted effect of primary rhinoplasty that I see commonly.
Given the degree of rotation of the columella segment compared to the alar segments I think a there is a significant chance the shortening of the nose at least in part was due to shortening of the septum.
There are two options I commonly use: 
1. Build on the current framework with de-rotating grafts in infratip lobule which will produce a modest derotation effect at best. The second is extending the septum with an septal extension graft. This latter choice would be the most classical and robust way of lengthening and derotating the nose.
If there is still excess inner lining and the soft tissue is pliable and flaccid then there is a chance wide underming including the lining and derotation in combination with a largish columella strut may hold the tip in a more derotated position ........ but this is a gamble and over correction of the derotation would be needed as some degree of relapse is always inevitable when the tip is not fixed.
If the skin envelope is tight, and also very importantly the inner lining is retracted then there is no other reliable option than creating a firm nasal tip. Without firm fixation of the tip in a derotated position the tip will in my experience slowly over time rotate upwards (even 5 years after) unless fixed securely in the lower position.

Selcuk Inanli, MD · Answer

Hello! Thank you for your question.From the photo you provided it looks like your nose is upturned and too lifted. You are already 1 year post-op so the result won't change that much with time.I recommend you a revision rhinoplasty surgery to achieve the result like on the simulation.I need a complete evaluation to say if you need extra cartilage or not to reshape the tip (from ear or rib).Best regards!

Randal Haworth, MD, FACS · Answer

If you are unhappy with the appearance of your nose after rhinoplasty and feel that it is over-rotated and too short, it's important to discuss your concerns with your surgeon. They may be able to offer options to help lengthen your nose without the need for a revision surgery.

One option may be to use cartilage grafts to help lengthen the nose. These grafts can be taken from other areas of your body, such as your septum or ear, and can be used to add length to the nasal tip. The type of cartilage graft used will depend on your individual needs and the amount of lengthening required.

Another option may be to use a technique called a "release" or "unrotate" procedure. This involves releasing the tight sutures that were used to rotate your nose during the initial surgery, allowing it to drop down slightly and appear more natural.

In some cases, revision surgery may be necessary to achieve the desired results. However, it's important to carefully consider the risks and benefits of any additional surgery and to work closely with a qualified and experienced surgeon.

It's important to communicate your concerns with your surgeon and to make sure that you fully understand the potential risks and benefits of any proposed treatment. Your surgeon may also recommend waiting until the full healing process is complete before considering any additional surgery or treatments.

Overall, the best course of action will depend on your individual situation and goals. It's important to work with a qualified and experienced plastic surgeon who can evaluate your situation, listen to your concerns, and help you determine the best course of action to achieve the results you desire.

Best of luck !

Can my nose be de-rotated without septal extension graft?

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Can my nose be de-rotated without septal extension graft?

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Everything you need to know about Revision Rhinoplasty

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