Do I have a tension nose? Should I be scared of Prolene sutures placed permanently inside my nose? (Photo)

Anne, you absolutely have the elements of a tension nose - your septum is overgrown (presence of a dorsal hump and blunting of the lip/nose transition on profile views). Best approach would be open, which gives the most optimal visualization of the middle portion (valve region) and allows for better precision (just my opinion). Your tip can be effectively narrowed with sutures and grafts.With respect to sutures, it is a surgeon preference and bears no impact on the outcome. I use both PDS and Nylon sutures internally, and have not seen any issues with either. Each offers advantages and disadvantages depending on the location and purpose behind placement.No one has a perfectly straight septum. Small deviations may be perceived as such by some surgeons, while others may disregard them entirely. Good luck,Grigoriy Mashkevich, MDNew York Facial Plastic Surgeon

The so-called "tension nose" refers to a high, narrow bridge and a droopy tip.  A wide, bulbous tip can be narrowed with sutures.  The choice of permanent (such as nylon or Prolene) versus dissolvable (such as PDS or Monocryl) sutures is a personal one and has little to do with the final outcome.  The problem with suture contouring of a bulbous tip alone is that it sometimes narrows the tip centrally but leaves bumps out laterally. My preference with wider noses is to narrow and, more importantly, flatten the cartilages in the tip with septal cartilage grafts (called lateral crural strut grafts).  These techniques can be done via a closed approach, but I personally obtain better results when lifting and narrowing a bulbous tip via the open approach. 

 I would like to answer your questions point by point to hopefully make a complicated concept clear to you. I am obviously responding to you based on what I see on three pictures. An examination would make it a lot easier to accurately answer any of your questions. A tension nose refers to a nose where the tips projection is maintained by the hight of the nasal bridge or dorsum. When the dorsum is lowered the tip will drop lower and needs to be supported by a columella strut, a cartilage graft from the septum. You may need this if the cartilages in your columella are not strong enough to support the tip of your nose and maintain its projection. For this you need to be examined. I would use an open approach because it is more acurate. Your tip should be narrowed by removing the upper part of your tip cartilage and suturing various parts together to create a narrower and more defined tip. The hump is then reduced and the bones are brought together to reestablish the arch. I use 6-0 nylon sutures because they are softer. I have never seen a problem with these sutures because the nods are never under the skin. Absorbable sutures can also be used successfully. The septum is never one hundred percent straight, but it only needs to be altered if it causes a significant airway obstruction. It is also used as a common source of cartilage grafts during a rhinoplasty. I think there is a lot more to discussed. A carefully done computer simulation could allow other areas like the junction between the lip and the columella as well as the shape and curvature of your lateral nostril wall to be discussed. I hope I answered all you questions.

   I use PDS to stabilize the tip during the healing phase, which is absorbable.  I think that your nose can be improved with a closed rhinoplasty approach without any visible scarring.  If you do not have any breathing problems, your septum is probably straight enough and not something I would change.Kenneth Hughes, MDLos Angeles, CA

Based on the photos you posted, you appear to have a long nose with a wide droopy tip, a poly-beak, along with columellar retraction and a slight "tension-lip". Many of these issues may be improved with well-performed rhinoplasty surgery. In our practice, we would employ an open approach with cartilage trimming and suturing. We no longer use Prolene sutures internally: we use 5-0 PDS which dissolves in around 3 months. Assessment of your nasal septum would only be possible during an examination.Hope this is helpful for you.Dr. Joseph

Hi Anne-
In these pictures you have a classic tension nose, as seen at the upper lip and bridge fullness.  The best thing to do is reduce the septal fullness at the bridge, and shorten the nose at the lip.  Tip defining can be performed as well as bony improvements.

 The diagnosis of a tension nose can only be made upon  examination and consultation. The rhinoplasty procedure can address shaving down the dorsal hump which is composed of both bone and cartilage. Medial and lateral osteotomies of the nasal bones are also required to close the open roof deformity once the hump has been removed. Sutured techniques to the lower lateral cartilages( inter-domal and intra-domal)  sutures are performed to narrow and refine the nasal tip. We used 5-0 PDS, not Prolene, due to  stitch abscesses we have seen in years past. Also important to release the depressor septi ligament, if present which pulls the tip down with animation. All this can be performed through closed rhinoplasty techniques. A septoplasty is only required if there is symptomatic airflow restriction through the nose by the patient, and there is evidence of blockage in the posterior portion of the nose. For many examples of  of noses similar to your own that we have repaired in our practice, please see the link below to our closed rhinoplasty  photo gallery