Preventing the Nose from Drooping Later After Revision Rhinoplasty?

Question

About ten years after I had rhinoplasty, I was talking to a surgeon and he said,   "You had a nose job? I can't stand it when they don't do something to prevent the tip from drooping in the future."
I'm ready for a revision now, and would like to know, what that something is?

Philip S. Schoenfeld, MD, FACS · Answer

As we age the support structures of the nose that provide the nose with shape and stability will stretch, elongate, and weaken. The nose looses some of its shape and the tip droops. In revision rhinoplasty situations, the previous surgical procedure has likely contributed to the lack of tip support for a variety of reasons. Interruption of major and minor supporting mechanisms of the nose is common in rhinoplasty. 
The key is to replace the natural support mechanisms of the nose with secondary mechanisms to help maintain the shape of the nose for years. Cartilage grafts are most common, called columella struts. These grafts should be placed at the time of your revision rhinoplasty surgery and are usually obtained from the septum or the ear.  These grafts act like a tent pole for your nasal tip and will provide long term stability.

Eric M. Joseph, MD · Answer

I think that a well placed Columella-Strut helps to keep your tip from drooping with time. These grafts measure around 20mmX4mm, and are carefully sutured to your tip-cartilage to add support. Septal cartilage is the best source for C-strut cartilage. This may be deficient since you've had previous surgery.
You should consult an experienced Rhinoplasty surgeon with many photos before you proceed.
I hope this is helpful for you.

Scott Trimas, MD · Answer

While you cannot absolutely prevent a nose from dropping some, you can minimize it from happening by placing struts between the medial crura or supporting feet of the tip. However, unless there is some intrinisic strength of these cartilages to begin with, the strut will not be able to withstand the weight of the skin over time. Another way to compensate for this is to suture or place the tip onto the stronger septum in a tongue and groove fashion but it depends on what your nose looks like to begin with. Ultimately, it should stay in position if the skin of your nose does not get heavier over time due to oil gland growth or stretching of the tip skin. I hope this information helps.

Steven J. Pearlman, MD, FACS · Answer

No one can prevent a nose from eventually drooping. As we age, skin stretches, cartilage and ligaments get weaker and like everything else in our bodies, things fall. However, the tip should not droop fast after rhinoplasty. Ways to prevent this might be cartilage support called struts, or sutures from the tip to the septum. Each individual needs to be evaluated for what either does or may occur depending on their anatomy.

Samir Shureih, MD · Answer

I am surprised that a surgeon makes such a comment without being asked.
The natural aging process makes the nose tip droop. And it is possible that with time your tip drooped. If this is bothering you then do the seond rhinoplasty. There are suture techniqes that can lift the tip fo a long time.
Using permanent prolene sutures will hold fo long time, then the scar will hold it up.

Richard W. Fleming, MD (retired) · Answer

The tip will always droop as we age: look at senior citizen residences. However it sounds like your tip has fallen rapidly. 
Does your tip position bother you or just the surgeon who described this to you? Tip support can be established with sutures or cartilage grafts placed in the columella. A second opinion may be helpful.

Oleh Slupchynskyj, MD, FACS (retired) · Answer

Hi,
Droopy tips can be a result of poor tip support of the lower lateral cartilages, over projected caudal septum or loss of skin elasticity in the nasal tip.
The " something" is making sure the surgeon does something to re-support your nasal tip. Such as, a caudal cartilage strut graft or a shield graft. Also it is important to maintain or re-support the major tip supports of the nasal tip. You may also need to rotate your nasal tip.
Best,
Dr.S.

Preventing the Nose from Drooping Later After Revision Rhinoplasty?

Answers (7)

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