In-Office Tip Release from CSEG – Is This Safe or Standard for Over-Rotation?

Question

Hi, I’m a male patient who had a septorhinoplasty. My surgeon over-rotated my nasal tip to a noticeably upturned position. This wasn’t something I ever asked for or agreed to. He’s now offering to do an in-office tip release from the caudal septal extension graft (CSEG) at 3 months post-op. He says he will cut the suture, make a full transfixion incision, and fully release the tip — claiming it will “significantly drop” the rotation. When I asked if this was common, he told me he’s never done this before in over 1,500 rhinoplasties. That makes me nervous. Is this a safe or medically accepted technique? Have you seen this work to reverse tip over-rotation, especially in men? Or is surgery in the OR typically needed for this? I’d really appreciate honest input — I’m trying to avoid doing something unsafe out of desperation.

Alejandro Nogueira, MD · Answer

Never ever accept office based procedures, you risk your life, your health, the procedure is going to be restricted technically and lacking precision, a no-go, red-flag, etc.

A shortened nose is not due to a caudal extension graft, that makes absolutely no sense given that a caudal extension graft de-rotates the tip; needless to say, don't belive the story of the trillions of rhinoplasties we're winning!

I must doubt you really received a caudal septal extension graft, due to the aforementioned reasons, no matter you'd been told so; probably you received a poorly thought/planned/executed tongue-in-groove maneuver (typical cause of over rotation if not well done) and the surgeon wants to undo it; is this a solution for your over rotation? I very much doubt so, nevertheless I did not see your images so take with a grain of salt this comment.

Eric M. Joseph, MD · Answer

Please consider re-asking your question with photographs. In our experience, sometimes septal extension grafts need to be removed completely, especially if it is leading to a long nasal appearance. If you wish to have your tip lowered, it is not clear to me whether or not that would happen with what was proposed by your surgeon, though the procedure that was proposed does not sound terribly invasive. I always encourage people to go with their gut. If you have uncertainties about what was proposed, it would never hurt to get a second opinion from another reputable rhinoplasty specialist. I wish you all moving forward. Sincerely, Dr Joseph

Richard G. Reish, MD, FACS · Answer

Hello and thank you for your question. That is not likely a plan which will work. If your tip is over rotated, this will likely require full release of scar tissue in the operating room and placement of extended spreader grafts. This is a very complicated revision and make sure you are truly going to an expert with hundreds of long-term before and after pictures on their website of tip derotations. With good surgical technique, you could have an outstanding result. I recommend that you seek consultation with a qualified board-certified rhinoplasty surgeon who can evaluate you in person.

Best wishes and good luck.

Richard G. Reish, M.D.
Harvard-trained plastic surgeon

Best wishes and good luck.

Richard G. Reish, M.D.
Harvard-trained plastic surgeon

In-Office Tip Release from CSEG – Is This Safe or Standard for Over-Rotation?

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