I understand that the most common method for decreasing the length of the nose is to raise the tip.On one rhinoplasty website however I have read of another method.When the anterior nasal spine is prominent and the upper lip is tethered,removal of the anterior nasal spine can shorten the nose by raising the position of the entire base of the nose,not just raising the tip.Would this be a good technique for improving a nose which is too long vertically? (length along the dorsum is ok).
Long Nose in Vertical Direction
Doctor Answers 8
Shortening a long nose
There are multiple surgical options to shorten the nose from a long vertical direction. One option is to lower the radix by rasping down the bridge close to the eyebrow area. This will shorten the nose. Another option is to reduce the anterior nasal spine and inferiorly projecting columella by trimming back the caudal and membranous septum. Turning the nasal tip up can also shorten the nose, however if it is turned up too much it will look operated upon. Lastly, an existing depressor septi muscle can be released to prevent lengthening of the nose upon animation and smiling.
Rhinoplasty for a long nose
I have performed Rhinoplasty for over 20 years and have found that sometimes the semantics of Rhinoplasty and its techniques are misconstrued by laypeople. The nose is described as long when one of two factors occurs.
- The tip is under rotated giving the illusion of length along the same axis as the nasal bridge.
- The tip, of the nose, is over projected "Pinocchio effect" in the vertical dimension
These are handled very differently during Rhinoplasty. Trimming the superior aspect, of the anterior septal angle, is one way that i have used for many years to rotate the nasal tip...this will however, IMHO have almost no effect in decreasing tip projection.
If the nasal tip is over projected, this must be addressed through an open tip plasty where the tip cartilages are trimmed, vertically decreased followed by re-constitution with multiple sutures to recreate a properly shaped nasal tip at a new lower level of projection. IMHO, any open tip plasty or Rhinoplasty, by the sheer nature of the dissection, causes the nasal tip to rotate 5-7 degrees therefore, if the nasal tip is at the proper angle of rotation (105 to 115 degrees depending on gender and height), the projection must be reduced through another method.
In this particulr case, I have shortened the columella by several mm's reducing the projection without changing the angle of tip rotation. Only a thorough evaluation, of your nose in person or by pictures will reveal the best method in your particular case.
Without photos it is dificult to advise. Usually the nose is shortened by trimming the caudal septum. If it is overprojected then any combination of lower lateral cartilage techniques and septal work can be used. If you are describing a hanging columella with excess alar columellar show due to an enlarged nasal spine and caudal septum then reducing the nasal spine may be of help. Otherwise its usually not necessary to work on the nasal spine itself to effect length.
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Long nose rhinoplasty.
It is impossible to say what would be best for your nose without photos. There are many more ways to do this depending on the problem.
Shortening the nose.
Without seeing photos it is diffiuclt to say, but if you are complaining about a long nose where it projects too much, and it is definitely not too much dorsal height, then think of it like pitching a tent. If the poles are too long they have to be shortened. This can be done with the lower lateral cartilages of both medial and lateral crura.
Reducing Vertical Tip Height.
Removing the anterior spine sounds a little drastic. You can achieve the desired result from shortening the Medial Crura of the Lower lateral cartilages and adjusting the dome and lateral crura of the lower lateral cartilages.
Length of nose can be adjusted several ways.
1- The length of the nose is defined as the distance from the radix (depression of the nose between your eyebrows) to the nasal tip.
2- You can shorten a nose by a) rasing the nasal tip or, b) lowering the radix.
3- The anterior nasal spine can be prominent which makes the lip look pulled and shorter. Once the lip looks shorter, the nose appears longer, but nothing has actually changed.
4- Any rasining of the tip or eliminating the anterior nasal spine is limited by the position of the nasal airway - for instance, if you raise the tip too high , you can see into the nostrils - not good!
These answers are for educational purposes and should not be relied upon as a substitute for medical advice you may receive from your physician. If you have a medical emergency, please call 911. These answers do not constitute or initiate a patient/doctor relationship.