Septum trimming under rhinoplasty - is this normal? (Photos)

Question

is it normal for a surgeon during a rhinoplasty to trim the anterior septal angel and not just lower the bridge of the nose? I am attaching a picture and drawing the area I saw a surgeon trimming the front part also of the septum in a video and the septum was not deviated. This does not create a problem for tip support? the first picture is the original and the second picture is how the surgeon trims the septum and the lower part as well.

Lucian Ion, FRCS · Answer

Thank you for your question and for providing the diagrams. The answer largely depends on the characteristics of the original nasal anatomy. In some cases, the lower portion of the septum is relatively prominent, and the degree of correction desired may not be achievable without trimming this area.

Reducing the lower septum does diminish intrinsic tip support; however, this is typically compensated for by using cartilage from the central part of the septum to reinforce the nasal tip, most commonly in the form of a septal extension graft placed between the tip cartilages.

The purpose of reducing the lower septum is primarily related to achieving the desired degree of tip rotation rather than providing support. As such, the overall adjustment involves a reduction along the vertical axis, combined with enhanced support along the horizontal axis to maintain stability and shape.

Eric M. Joseph, MD · Answer

Everybody has ligaments that extend from the bottom of the septum to the nasal tip, and by definition, when the caudal septum is trimmed, these ligaments are severed. In that regard, maneuvers must be done to ensure tip stability, to prevent droopiness, after nasal septal shortening is performed. I hope this helps. Sincerely, Dr Joseph

Elie Ramly, MD · Answer

This is a thoughtful and technically informed question. In rhinoplasty, the septum serves multiple roles, including dorsal support, tip support, and long-term nasal stability. How the septum is modified depends on the aesthetic and functional goals of surgery and the overall structural plan. In some cases, surgeons may trim portions of the anterior septal cartilage as part of dorsal hump reduction or overall contour refinement, even when the septum is not deviated, but this must be done thoughtfully and in balance with other support mechanisms.
The key issue is not whether septal cartilage is trimmed, but whether adequate nasal tip support is preserved or reconstructed using techniques such as preservation of an adequate septal L-strut, the use of a septal extension graft, or other structural grafting strategies. When anterior septal support is reduced without appropriate compensation, it can contribute to long-term tip weakness or changes in nasal tip position. Because surgical videos often show only one step of a multi-step rhinoplasty technique, it’s not always possible to assess the full structural strategy without seeing the entire operation and final result. I am answering this question based on the information and drawing you provided, but this has to be placed in full context for a more complete answer. A detailed in-person discussion with a qualified plastic surgeon who specializes in rhinoplasty is the best way to understand how septal modifications are planned while maintaining long-term support and stability.

Jeffrey H. Spiegel, MD · Answer

This is done when necessary to rotate the nose or change the columellar show, and a few other reasons.  Do you like the way your nose looks? If so, don't worry about how it was done.  If you do not like it, don't worry about why, just speak with your doctor.

Richard G. Reish, MD, FACS · Answer

Hello and thank you for your question. Yes that can be a normal maneuver. Make sure you are going to a surgeon with hundreds of long-term before and after pictures on their website with standardized lighting and standardized backgrounds. 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

Best wishes and good luck.

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

Septum trimming under rhinoplasty - is this normal? (Photos)

Answers (5)

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