Septal extension graft - Is it possible to reverse the overprojected tip?

Question

Is it possible to reverse the overprojected tip? I was happy with my profile before but my primary doctor somehow elongated my tip. From my operative report, he did a septal extension graft and an ear cartilage to the tip. Im not sure if he did a tongue in groove technique. What are the risks involved and how different will it look at frontal view to trim the grafts put?

Steven M. Denenberg, MD · Answer

Your nose looks long to me, with the tip hanging down, like the woman whose images I posted in the link with my answer. I'd like to see your tip come up, quite a bit actually. If most of the excess length is due to the grafts, then yes, the grafts would be trimmed, or more likely removed entirely. The good news is that usually, elevating a drooping tip is one of the more predictable changes to make in a rhinoplasty, even a revision, if done by an expert.

How *much* to elevate the tip, or make other changes? We figure that out with morphs, well before surgery. I'd love for you to see some excellent professionally-designed morphs of what could possibly be done with your nose. Morphs could also help you identify better just what's bothering you, and help you set a goal for the rhinoplasty that's accurate for your tastes. Profile and three-quarter views would be particularly important in morphing your nose. (Side note: in my opinion, morphs should really be done by the surgeon, or he should direct an assistant as she makes the morphs. Morphs should be made with a constant eye to what actually *can* be done in surgery, for that particular nose, and the surgeon has that information and judgment best.)

Remember that rhinoplasty is an exquisitely difficult operation to get right, and you should only have surgery if you are able to make yourself very confident in your surgeon's skills. The changes that your nose needs require advanced techniques, and skill that most plastic surgeons don't possess with expertise. For most noses, it's much better to not have surgery than to have inexpertly-performed surgery. Read my essay on how to stay out of trouble while selecting a rhinoplasty surgeon. And for those who have had previous surgery, it also discusses how to tell whether your first surgeon should be performing your revision. And it also discusses how to take photos that are best for online evaluations.

Eric M. Joseph, MD · Answer

You appear to have a lot of fullness, perhaps swelling, involving your nasal tip, and the feasibility of surgery is impossible to determine with your singular photo. Consider reasking your question with before and after photos, or consider visiting another rhinoplassty specialist to review your operative report and photos. Wishing you the best. Dr Joseph

Jeffrey H. Spiegel, MD · Answer

Yes - you can have this revised.  I agree, the nose looks fairly projected and it may be that too much graft was placed, or, that not enough was placed at the "Radix" higher up on the nose.  Essentially, it's a revision rhinoplasty and you should get nice improvement.

Septal extension graft - Is it possible to reverse the overprojected tip?

Answers (3)

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