Revision Rhinoplasty for Severely Overturned Nose? (photo)

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.

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.