Can a nose derotation have a successful outcome?

There are quite a few techniques that reliably lengthen or derotate the nose.  All require additional cartilage to secure the new position, and most often can be taken with primary rhinoplasty from the septum.  Septal extension grafts, extended spreader grafts, complex columellar struts, tip grafts.  All are recognized and accepted techniques.  Your surgeon can describe his or her preference(s), and give examples of their relative power.  There is a limitation on movement, based on materials, complexity, and skin redraping.  These are all issues to discuss during your consult.  With open communication, and modern day software, you should be able to match your goals to those of the surgeon. 

If you go on our website and those of other surgeons who do a high volume of nasal revisions you can see the surgeon's results. Some noses are so scarred after 5-6 rhinoplasties, I can't get as much derotation as I would like.

Derotation of the nose is indeed a very difficult problem to fix. There are multiple different techniques that can derotate the nose which can include different cartilage grafts between the upper and lower lateral cartilages, extended spreader grafts, full transfixion incision resecting the inferior portion of the nasal spine, and cartilage grafting across the bridge. All of these maneuvers work to derotate the nose, but it really depends on what is causing the over rotation of the nose to start with. 

If you have this problem and it is bothering you there is only one way of changing the appearance and that is through a revision rhinoplasty. So, as you know, you need to find a surgeon whose skill and photos you trust. Results, even in good hands can be hard to achieve in severely scarred or re-operated noses. As for photos, you may find that even experienced surgeons do not have many photos of the type you are looking for. Sometimes the photos can 'minimize' the actual result. Sometimes differences aren't significant enough and just aren't shown. A good substitute, if you otherwise feel good about the surgeon, is to look at primary rhinoplasties on patients with short noses, flattened tips and decreased nasal tip projection. Usually improvement of some kind can be attained. It will be important for your surgeon to set your expectations reasonably - honesty on the part of your surgeon will be very important for you. Also see at least 2-3 surgeons before making any decision.  Good Luck

Regarding: "Nose Derotation Successful?
ive read on here how difficult it can be to derotate a nose. the pictures i have seen of the procedure show minimal results also. i am considering getting this done, but would like some reassurance that this can be done with a good outcome. also if you have any pictures of a successful derotation please show them. thanks"

Derotating the nasal tip, or more descriptively put, the changing of a swine-like, full nostril demonstrating nose on forward gaze, requires the tip to be mobile, the skin to be supple and cartilage strip grafts to do the forward and down pushing and support.

Without a face to face examination, much less a single photograph, how can any ethical surgeon give you a blind assurance that anything would work in YOUR case?

See an experienced nose surgeon and learn what is applicable for you.

Good Luck.

Dr. Peter Aldea

What you are describing is referred to as short nose or pig nose.  The most common technique for correction is to elongate the nose, by using extension grafts.  These are usually taken from the septum, if available.  If not, ear or rib cartilage can be used.  I have also used Medpor, which is synthetic porous material for these situations where patient's cartilage was not available.

Nasal derotation often happens in primary rhinoplasty( accidentally), however, for patients that need it because they desire a revision, it can be difficult if they have had several rhinoplasties and very scarred in tissue.

Hi,

Yes the tip can be derotated successfully. It may require cartilage grafting and/or tip reconstruction. Make sure that's the procedure that you need

Best,

Dr.S.