How is a Nose Made Longer?

Question

I had an attractive long nose and just wanted it a bit slimmer and ended up with a short, stubby, piggish, bulbous nose. I am told I have no septum or cartilage left. What does a plastic surgeon usually do to make a nose longer again? Do you do anything with the septum?

Anthony Corrado, DO · Answer

The shortened nose or "pig nose" deformity is a common complaint following rhinoplasty surgery. In order to lengthen the nose special grafts will have to be placed during revision surgery. "Septal Extender" and "Extended Spreader" grafts can be placed to increase length. Since you do not have septal cartilage, I would prefer to use rib cartilage for the procedure. Rib will provide the most durable and lasting effects for this situation. Good Luck....Dr. Corrado

Scott Trimas, MD · Answer

This is one of the more complex rhinoplasty procedures. Lengthening a nose that has been made too short from a previous rhinoplasty requires grafting usually from a rib or ear or both in order to achieve the necessary length since there is generally very little septum left to work with. Alternatively, irradiated rib cartilage from another source can be used as well. I would seek the consultation of a skilled rhinoplastic surgeon who specializes in revision procedures.

Toby Mayer, MD · Answer

If your nose is short and there is no septal cartilage left, we usually go to the ear. The rib can also be used but is much more uncomfortable.

William Portuese, MD · Answer

It is very difficult to make the nose look longer without any cartilage grafting. It is one of the most difficult maneuvers to perform during a rhinoplasty operation. In trying to gain length, many times the tip of the nose comes up and looks too upturned. There are some tip techniques that are performed such as dome suturing techniques with cartilage struts and tip grafts to give more projection to the nasal tip, but we are only talking about several millimeters, not a large change. Scar contracture is also working against a tight skin envelope if this is a revision rhinoplasty.

Peter A. Aldea, MD · Answer

Regarding: "How is a Nose Made Longer?
	I had an attractive long nose and just wanted it a bit slimmer and ended up with a short, stubby, piggish, bulbous nose. I am told I have no septum or cartilage left. What does a plastic surgeon usually do to make a nose longer again? Do you do anything with the septum?"

	Your story is tragic and unfortunately too common. Nose surgery is the real life surgical version of playing with a house of card. Here every change to the nose affects every other nose structure and removing or changing too many structures can result in nasal collapse.

	I seriously doubt that a single rhinoplasty to narrow your nose and make it slimmer resulted in a shortened, collapsed piggish nose without a septum. The usual scenario is SEVERAL operations in which the septum is lowered to reduce a hump or deviation followed by its use for cartilage grafts to correct other nasal deficiencies, followed by scarring shortening and collapse.

	The more operations a nose undergoes, the harder / impossible it is to return it to its former appearance.

	I would advise you to see a Plastic Surgeon who specializes in nose reconstruction surgery since I suspect a shortening of the nose is not the only thing wrong with it. An exact identification of what needs to be corrected must be made and a plan formulated based on this plan. Since the septum is largely gone, nose support and lengthening would have to be based on a rib cartilage secured to the forehead bone as a cantilever.

	Good Luck.

	Dr. Peter Aldea

Steven Wallach, MD · Answer

Rebuilding a nose can be a bit more difficult than reducing one.  An exam is necessary and review of your previous surgeries.

Yael Halaas, MD · Answer

Cartilage is one of the key component s in determining the appearance of the tip of the nose. Finding enough cartilage to reshape your nose is essential. Using cartilage, the nose can be refined, elongated and sculpted. The septum does help provide support for the nose and can be used to help create the desired look. If you do not have any cartilage left, then cartilage can be taken from donor areas such as the ear or even rib. Discussing your results with the surgeon who performed the procedure can be a good first step. Then you can proceed with a revision or consider a secondary consultation with an experienced rhinoplasty surgeon. Good luck!

Brooke R. Seckel, MD, FACS (retired) · Answer

I am sorry to hear of your experience.  Cartilage grafting is usually necessary to improve a tip that has been shortened by rhinoplasty.  Typically strut grafts and onlay graft can be done to refine in length in the tip.Since you have no septal cartilage tear cartilage can usually be used to perform these procedures.Obviously you need to find an expert in rhinoplasty surgery.  Revision rhinoplasty is difficult and requires the skills of an experienced plastic surgeon.

Richard W. Fleming, MD (retired) · Answer

Cartilage grafts from the ears or ribs are used to restore proper nasal length. This graft will also restore septal structure and function.

How is a Nose Made Longer?

Answers (9)

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