Long Nose in Vertical Direction

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.

Although it is hard to tell without seeing your pictures what you are describing is possibly true - best of luck

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. 

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.

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.

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!

 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. 

Hi,

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.

Best,

Dr.S.