How is a Nose Made Longer?

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.  

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