What is the best way to lengthen an overesected upturned nose? Who is the best revision specialist for short noses?

Question

Alejandro Nogueira, MD · Answer

The length of a nose (distance between radix and tip, this is the dorsum) is conditioned by the nasal structures, from top to bottom: nasal bones (hard nasal wall) >>> upper lateral cartilages (soft nasal wall) >>> the tip tripod: lateral cruras, medial cruras and septum; may one or more of the former be underdeveloped or oversized you'd get, respectively, a short or a long nose in need of, also respectively, lengthening or shortening.
If you suffer one short out of the former pillars then each of them lacking adequate length has to be individually addressed:
-short bones: nothing should or can be done directly to length them, but indirectly they can be compensated lengthening or adding a surplus or lengthening to the upper lateral cartilages
-short upper lateral cartilages: some surgeons advocate using specific spreader grafts ouside (instead inside) the upper lateral cartilages to lengthen them; well yes, this works, but only at the dorsum and might leave a hollow area at the lower end of the nasal wall right about the lateral crura; I prefer a more comprehensive approach applying an onlay graft at the nasal wall above the mucosa exposed by the lengthening and sutured directly to the caudal end of the upper lateral cartilages and the dorsal septum, a kind of upper lateral cartilage caudal extension graft
-the tip tripod: lateral cruras extended with caudal extension grafts like batten; medial cruras extended by my personal technique of roll-over (the dome of the alar cartilage is rolled out and straightened to be part of the medial crura, and the tip rebuild with a nicely shaped Sheen's graft, which itself adds tip projection/length as well, though not nasal length); the septum, the most troublesome part, lengthened by one-on-one septal graft, L mounted caudal extension grafts or both together (common in ethnic noses); minor tip-columella derotations may be accomplished by simplest shield columella graft (en bloc tip-columella)
Your case, as anyone's has to be experiencedly and judiciously assessed and individually planned; keep in mind undergoing a revision equals to sign a blank consent authorizing the surgeon to performe whatsoever maneuver are deemed required after the only valid intraoperatively scenario analysis.You should be operated by a surgeon able to show you in person his intraoperative images about his nasal lengthening cases; before and after are not always reliable, you know what I mean... do seek intraoperative images of septal lengthenings, lateral crura grafting, columella grafts, etc in ethnic and revisional cases... these introp works photos can't be successfully edited, ripped from someone else or touched up.

Robert S. Schmidt, MD · Answer

Thanks for your question. Over-resected, short noses require cartilage grafts to improve them. Usually we use extended middle vault spreader grafts which will widen the middle vault to help breathing and bring down a overly rotated tip. That would be the foundation. Other grafts can help, but it depends on the specific needs of your nose. Good luck!

Jawed Tahery, FRCS · Answer

Dear 0908,There different techniques to over-rotate a shortened nose!would be happy to advise about ins and outs if you could provide some pictures !Best wishesMr J TaheryOtolaryngologist /Facial Plastic SurgeonChesterUK

Francis R. Palmer, III, MD (retired) · Answer

Hi, I have performed and taught Rhinoplasty for 30 years.  Correcting an over-rotated (upturned) nasal tip is very difficult.  Photos of your nose form the front, side and base view (looking up at the nostrils) would help in the evaluation and determination of the most appropriate course of action.  Hope this helps.

What is the best way to lengthen an overesected upturned nose? Who is the best revision specialist for short noses?

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Answer: What is the best way to lengthen an overesected upturned nose?

Answer: What is the best way to lengthen an overesected upturned nose?

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What is the best way to lengthen an overesected upturned nose? Who is the best revision specialist for short noses?

Answers (4)

Answer: What is the best way to lengthen an overesected upturned nose?

Answer: What is the best way to lengthen an overesected upturned nose?

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Everything you need to know about Revision Rhinoplasty

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