Revision Rhinoplasty for Severely Overturned Nose? (photo)

Question

It's been 15 years since my original rhinoplasty. I am wondering if there is anything that can be done to lengthen my over rotated nose? Not only am I unhappy with the profile, as you can see from the front view, my nostrils are prominent and i have a hanging columella. How can this be corrected? Is it a difficult procedure? What can I expect the cost to run?

Thomas A. Lamperti, MD · Answer

Yes, it is possible to improve your tip position and upturned appearance. This is complex surgery so you want to make sure your surgeon has experience treating this type of problem.

	Cartilage grafting is typically required to reposition and stabilize the nose during surgery.

	You can read more about upturned nose correction at my web reference link below.

Donald B. Yoo, MD, FACS · Answer

Your nose can certainly be improved with a revision procedure. The tip of your nose has been significantly over-rotated (pushed up), and so a septal extension graft will likely be needed to push it back down to a more attractive position. By pushing the tip of your nose down (counterrotation), it will reduce the prominence of your nostrils from the front. Based on your pictures, you will need quite a bit of cartilage to reconstruct your nose, so rib cartilage harvest is likely necessary. For an experienced revision rhinoplasty surgeon your case is commonly encountered.

Paul S. Nassif, MD · Answer

Improvements can be made with a revision rhinoplasty. Grafts can be used to improve the appearance of your nose, and it would be best to seek the advice of a board certified revision rhinoplasty specialist. He or she may use computer imaging software to give you an idea of how the final result may appear. Cost of a revision can vary depending on the individual circumstances of the patient. Look for a board certified surgeon who has great patient testimonials and many before and after photos, I hope this helps, and best of luck to you.

Craig S. Murakami, MD - Account Suspended · Answer

This can be correct, but it will require extensive grafting. Typically, this will require cartilage grafts from your ear or rib to lengthen and de-rotate your nose. Your surgeon should be experienced in revision rhinoplasty surgery. You will need to spend a significant amount of time reviewing your expectations against possible surgical outcomes. Good luck with your search.

Christopher Kolstad, MD · Answer

Hello,

Thank you for providing photographs with your question.  It makes having a meaningful discussion about your concerns a little more realistic.

Scooped bridges, over-rated and pinched nasal tips were much more common 15 years ago then they are today.  Rhinoplasty techniques have evolved and I like to believe that most surgeons currently performing this procedure recognize that smaller is not always better.

For many people with over-rated nasal tips they can frequently find significant improvement with revision rhinoplasty.   That being said, lengthening a foreshortened nose is one of the most challenging components of revision rhinoplasty.  It almost always requires the use of rib cartilage to create a number of grafts to rebuild your nose.

Improving the rotation of the tip of your nose,  the hanging columella and the visible nostril show on front view can all be achieved with revision rhinoplasty.  These are advanced techniques and I would recommend meeting a surgeon  that specializes in noses and has a large volume of revision rhinoplasty.  During a consultation your surgeon can assess the tightness of your nasal skin which is commonly the rate limiting factor to how much length and rotation can be achieved.

Hope this helps.

Richard Clark, MD · Answer

Although the overly rotated
tip is congenital in some people, all too often it is the consequence of the
surgeon not recognizing that reducing the hump or bridge along with the
standard procedure of trimming the upper edge of the wide tip cartilages results
in loss of the support system that was keeping your nose from being too turned
up. If the septum is shortened at its caudal [lowest] end the same thing can
happen. Certainly this is not a primary concern if you have a droopy tip to
begin with, but if you already have a borderline open angle between the upper
lip and the columella and borderline too much nostril show...you end up with a
Miss Piggy nose. Not a flattering term but your distress is palpable and you
need to know there are specialists who have devoted themselves to this specific
problem. I have over 25 years of experience de-rotating the tip and depending
on the cartilage available and how much internal nasal mucosa can be
stretched...at least a partial and perhaps an elegant lengthening of your short
nose will happen. By the way...just to not be confusing...length is the
vertical distance when standing from the upper point between the eyes where
nose begins [separates from forehead] to the tip at its most projected aspect.
Sometimes the tip will come down and the nostrils still flare and appear too
arched and, therefore, a simultaneous borrowing from the ear [with typically
not obvious scar] of a composite graft of skin adherent to cartilage must be
placed inside the nostril rim to lower this area as well. As you can tell this
is very sophisticated surgery and the doctors with experience and devotion to
the nuances of this surgery are few and far between. I prefer to do this
procedure closed and others do it through an open approach. I prefer not to
scar the columella and since this columella is bearing the stress of the
lengthening tension...I think it should not be cut. The most important thing is
that you see results from the surgeon solving the exact problem and solving it
will artistry. I wish you success.

Chase Lay, MD · Answer

Thanks for your inquiry

	 

	essentially everything you've been told thus far are the other physicians on Realself.com is accurate. You'll need a significant amount of cartilage grafting from your ear to extend the length of the nose, rebuild the mid-vault of your nose and make it straight again on profile, and the rotate the tip and nostrils. I think the one limitation you'll see from any surgery you get is that the nostrils may continue to have a certain amount of flair from retraction. This can be improved quite a bit but it may not be perfect and you need to understand that. Revision rhinoplasty after anesthesia fees, surgeon fees, etc. will most likely cost you anywhere from $10-$15,000.it is possible to do this under local anesthesia which would probably reduce your overall costs by around $5000.

	 

	I hope that was helpful

	 

	Chase Lay, MD

Steven Wallach, MD · Answer

It does not look like you have a hanging columella. You have an over-rotated tip and grafts would be needed in an attempt to derotate it.  Good luck.

Kimberly Lee, MD · Answer

The nose can be lengthened to rotate the nasal tip downwards to create a more natural appearance by using cartilage from your own body. By doing so, the appearance/location of the columella will also usually be improved as will your nostrils. While revision surgeries are always more extensive than primary ones, you want this to be your second and last surgery, so finding the right surgeon who shares your aesthetic goals and eye with the most advanced surgical techniques is critical. Please consult with a board certified specialist who can best assist you in achieving the results you seek.

Michael L. Schwartz, MD · Answer

You have described yourself well. You do have a shortened over rotated nose with a lot of nostril show. All of these problems are correctable with a revision. A variety of techniques including the use of cartilage and possibly composite grafts will be necessary to correct this. You need to have consultation with rhinoplasty surgeons that are experienced with this kind of problem and do it regularly. Ask to see photos of revision patients like yourself and see how they came out. Revisions of this type are usually more expensive then routine rhinoplasty. This is due to complexity and increased operative time. This is not the time to look for the least expensive option as that may get you into worse shape. While prices vary I would guess that a range of $8-12,000 would exist for total cost. Good luck.

Revision Rhinoplasty for Severely Overturned Nose? (photo)

Answers (13)

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