Does derotation of the tip also require overall lengthening of the nose? (Photo)

Question

2 years ago I had a revision rhinoplasty. My nose was shortened and overly rotated upward. I hadn't asked for either. I am okay with the shortening of the nose length. However I do not like the tip position. (nor projection). Can the tip be derotated without increasing the overall nose length? Petrified of getting my old long nose back.

Steven Wallach, MD · Answer

It is always nice to compare prep photos with post-op photos. It might be possible to improve the overall shape and lower the tip.  How long has it been from your last surgery?

Eugene L. Alford, MD · Answer

Thank you for the photos they are helpful. From the lateral view your nose is definitely over rotated. I also think you have a bit of alar retraction. To create a more pleasing appearance the tip must be lowered which can give the illusion of more length. However the actual length of the nose will not change. If we correct the alar retraction at the same time the balance of your nose will be restored and your nose will not look longer. Find a skilled facial plastic surgeon who specializes in revision rhinoplasty for your best chance at a good result

R. Stephen Mulholland, MD (retired) · Answer

Dear Merelself,

Thank you for your clinical post.  It appears after your revision rhinoplasty
there is a over rotation of the tip with a over projection, as well.  This gives an excessive “scoop” deformity of
the nasal bridge, which was attractive in the 70’s and 80’s, but generally the
aesthetic is more towards a straighter bridge.

Derotation of the tip can be performed to a tertiary
rhinoplasty usually external in nature and this give the illusion of your nose
slightly lengthened.  However, the
illusion of the length in nose as in your image post-op is not excessive and
generally balance and proportion between your forehead and chin can be
maintained.  By slightly resecting the
caudal septum at the time of derotation even the apparent lengthening of the
nose can be minimized.

I think that the illusion of a lengthened nose will more than
compensate for deep projection of an over projected tip with a “scoop nose”
aesthetic appearance.There also appears to be in the front view a slight alar base
asymmetry and this might be able to be corrected at the same time.

Two or three consultations with experienced rhinoplasty
surgeons either plastic surgeons with rhinoplasty experience or
otolaryngologists with rhinoplastic experience and definitely 2D or 3D computer
imaging to show the type of images you might achieve post-operatively will be
important.  I find after performing
cosmetic rhinoplasty for over 20 years that the computer imaging is invaluable
to show the kind of limitations we often have in secondary and tertiary
rhinoplasty.  Expectations need to be
realistic and I think that you can achieve a much more pleasing nasofacial
balance and proportion.

Also, the functional aspects of your nasal airway need to be
discussed to ensure that in deep projection of the tip we should not cause any
internal valve disruption or exacerbation of any airflow obstruction. I am fortunate in that I trained in both plastic surgery and
ear, nose, throat, head and neck oncology and cosmetic rhinoplasty has been a
big part of my practice for 20 years. 
Consultation with computer imaging would help you assess the kind of outcomes
that may be achieved.

I hope this information has been of some assistance and best
of luck.

For more information, please review the link below.

R. Stephen Mulholland, M.D.

Certified Plastic Surgeon

Yorkville, Toronto

Does derotation of the tip also require overall lengthening of the nose? (Photo)

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