Can my nose be deprojected with medial crura reduction under local anesthesia? (photo)

Question

I am one year post primary rhinoplasty. I am very happy with my front profile, however I feel my side profile is over projected. My surgeon has suggested a procedure under local anaesthetic called a “medial crua reduction” which they said could de-project 4mm. Is this possible and would it likely achieve my desired result as per the photo? Or would I need a full revision?

Eric M. Joseph, MD · Answer

Deprojecting your nasal tip may lead to a wider nasal appearance on front view, and I do not believe this could be performed with local anesthetic in the office. Since your bridge is a bit too low, depending on your examination, microdroplet Silikon-1000 injections maybe considered for raising your bridge so that you tip should not appear to look over projected. I hope this helps. Sincerely, Dr Joseph

Richard G. Reish, MD, FACS · Answer

Hello and thank you for your question. Based on your photograph, you are a great candidate for nasal tip deprojection revision. However, this should be done under general anesthesia as part of a full revision and never an isolated procedure under local. With good surgical technique, you could have an outstanding result. I recommend that you seek consultation with a qualified board-certified rhinoplasty surgeon who can evaluate you in person.

Best wishes and good luck.

Richard G. Reish, M.D.
Harvard-trained plastic surgeon

Ruslan Zhuravsky, DO · Answer

Hi, the overall answer is yes, it should be possible to achieve this under local anesthesia.... but here are some details:As far as the deprojection itself goes, there are many different techniques to accomplish this and they are chosen based on the individual case. In your case it will mostly depend on what techniques were used to set the tip projection during the first surgery. The medial crura support the tip cartilages, so either reducing them, lowering them, or overlapping them can achieve a deprojection. You must be careful to account for the derotation (turning down of the tip) that can result from these techniques. Making sure there is good support for the tip to maintain proper rotation but lower projection will be key and should be taken into account. If there is a septal extension graft, it can simply be placed lower along with the attached tip cartilages. If the cartilages are set onto the septum in a "tongue in groove", they can be set lower. Without knowing the structure and primary techniques of your nose, it's difficult to say for certain. However, if you trust your surgeon and they know the specific anatomy of your nose, it seems like a reasonable option. I am however always a big fan of using techniques that spare cartilage when possible. Ask if loosening the tip support between the septum and tip cartilages, then setting the tip lower is a viable option for you, or a medial crura overlay instead of a reduction. As far as doing this under local, yes it is possible. I personally do majority of my rhinoplasties (including difficult revisions) under local and my patients do great! Once the area is injected with numbing (like a dental procedure) you shouldn't feel any pain. Good luck!

Mats Hagstrom, MD (license on probation) · Answer

Reducing an excessively projected nose can be challenging.
It’s not difficult to do under the door some, but it can be challenging on the lower part of the nose.
This can also be amplified with dorsal reduction.
I suggest you ask your provider to show you examples of previous patients who’ve had this procedure done.
That’s the best way to understand what the procedure can accomplish and also get a clear understanding of your providers experience with this technique.
Best,
Mats Hagström MD

Can my nose be deprojected with medial crura reduction under local anesthesia? (photo)

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Can my nose be deprojected with medial crura reduction under local anesthesia? (photo)

Answers (4)

Answer: What a procedure can or cannot accomplish

Answer: What a procedure can or cannot accomplish

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Recommended reading

Everything you need to know about Rhinoplasty

Our mission is to create a world where every investment in modern beauty is Worth It.