Will an Over-reduced Nose Cause a Lack of Support to the Upper Lip?

I had rhinoplasty 4 years ago and the doctor over resected removed my nasal spine and cut the depressor muscle. Ever since my upper lip feels very different, like there is nothing supporting it. My nasal tip moves very easily and has no support. I have an inverted V and a slight pinched tip. When I wear a breathe right strip, my nose and upper lip feel more natural and supported. I was wondering if I would get the same relief if I had a revision with spreader grafts.

Doctor Answers 9

Absence of Nasal Support

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Based on your description, it seems that you are a great candidate for a multifaceted corrective rhinoplasty.

Columellar strut grafting will help with supporting your nasal tip that may require modifications depending on its current status.

Spreader grafts will help with your breathing (recall that you feel best with breathe right strips) and will reflect aesthetically over the nose shape overall.

Further modifications may be necessary depending on your facial features and what you have as goal to achieve by having the corrective procedure.

Without in-person evaluation it is not possible to provide you with further details that would best fit your case.

That being said please remember that commendable results require an exceptionally skilled surgeon to perform the surgery and settling for anything less than that increases the chances of additional corrective surgeries dramatically.

I hope this helps.
Thank you for your inquiry.
The best of luck to you.


Dr. Sajjadian

Orange County Plastic Surgeon
5.0 out of 5 stars 205 reviews

Inadequate Nose Support

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The result of inadequate tip support can typically result in a drop of the tip with resultant elongation of he upper lip.  The goal in your case would likely be to address the fundamental problem, lack of tip support, with most likely a cartilage graft as a columellar strut, along with whatever else is indicated.

Jeffrey Epstein, MD, FACS
Miami Facial Plastic Surgeon
4.7 out of 5 stars 145 reviews

Over-reduced Nose

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Over-reduction of supporting structures is the most common reason I do revision rhinoplasty.  All the issues you have can be addressed by restoring support mechanisms with cartilage grafting from septal, ear or rib cartilage.  A columellar strut graft can help alleviate a drooping or flaccid nasal  tip.  Lateral crural strut grafts can both support your breathing and help alleviate the look of a "pinched tip".  Spreader grafts can both make your nose look and work better by addressing the inverted V deformity and opening the nasal valves.  You shouldn't have to turn to breathe right strips for relief.   It sounds like you need revision rhinoplasty.

James C. Marotta, MD
Long Island Facial Plastic Surgeon
4.9 out of 5 stars 120 reviews

Candidate for revision rhinoplasty

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Based on your description you sound like a great candidate for revision rhinoplasty. Spreader grafts can help improve your airway, especially if you find relief with breathe-right strips. To support your tip, you likely need a columellar strut graft. If needed, your upper lip can be lifted through an internal approach at the same time. The inverted V deformity can also be improved at the time of the revision. In some cases a fascia graft can help correct this and provide an un-operated look. I recommend consulting with a board certified plastic surgeon or facial plastic surgeon *with experience doing revision rhinoplasty*, and get a comprehensive evaluation.

Anita Patel, MD, FACS
Beverly Hills Plastic Surgeon
4.7 out of 5 stars 12 reviews

Help For an Over-reduced Nose after Rhinoplasty

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Your result is one of the reasons that most of us have changed the way we do rhinoplasty surgery. In the distant past, most rhinoplastys involved removal of quite a bit of tissue- bone, cartilage, soft tissue, and muscle.The problem with this type of surgery is exactly what you are experiencing- poor breathing, no tip support, and an unnatural, pinched appearance that develops over time. Current rhinoplasty dogma is to spare as much cartilage as possible which prevents these issues. You are right about spreader grafts (which will likely help with both breathing and the inverted V deformity), but given your other issues you will likely need multiple cartilage grafts to strengthen and support the tip. The cartilage could come from your septum (if there is enough cartilage left after your previous rhinoplasty), your ear, or from a donor rib graft (which would probably be best). Experience and volume is the key to finding the right surgeon to do this procedure. These surgeries are among the most difficult we do so you need to sure that your surgeon does a lot of these kinds of cases.

Michael R. Menachof, MD
Greenwood Village Facial Plastic Surgeon
4.4 out of 5 stars 28 reviews

Wow what a dilemma

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You have what revision rhinoplasty books are written about. These are popular problems that revision rhinoplasty specialists like myself see every day. We like to say they are hard to fix and they are for  surgeons who dont do revisions... iIf you send me pictures I can give you a better evaluation...send photos to sarah at beverlyhillsbody.com my consultant who receives all the pictures

Richard Ellenbogen, MD
Los Angeles Plastic Surgeon
4.7 out of 5 stars 30 reviews

Will an Over-reduced Nose Cause a Lack of Support to the Upper Lip?

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 IMHO, it's the resected depressor muscle and anterior spine reduction that may have decreased upper lip support and or volume.  Photos or an in person evaluation would be required for further evaluation.  In these cases a crushed cartilage plumping graft, fillers to the area and/or upper lip augmentation might be suggested.

Francis R. Palmer, III, MD
Beverly Hills Facial Plastic Surgeon
4.7 out of 5 stars 28 reviews

Over Reduced Nose

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You're correct when your suggest that spreader grafts will improve your breathing and correct your inverted V deformity. It sounds like you need a columellar strut graft to support your tip. Grafts will also be necessary to correct the pinched tip. A revision to reconstruct your nose should be done by a experienced revision rhinoplasty specialist.

Richard W. Fleming, MD
Beverly Hills Facial Plastic Surgeon
4.9 out of 5 stars 43 reviews

Over treated nose?

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It sounds like you have multiple issues going on.  Without an exam it would be hard to suggest what can be done.  Good luck.

Steven Wallach, MD
New York Plastic Surgeon
4.2 out of 5 stars 30 reviews

These answers are for educational purposes and should not be relied upon as a substitute for medical advice you may receive from your physician. If you have a medical emergency, please call 911. These answers do not constitute or initiate a patient/doctor relationship.