We have been getting numerous questions lately about whether it’s possible to fix an overshortened nose. A large part of our practice is helping people who previously went in for rhinoplasty with a plastic surgeon to fix a specific complaint and did not get what they were hoping for. Of all of these unhappy people, those with over-rotated noses (turned up too much) or over-shortened noses are some of the unhappiest. This is a harder problem to fix but it can most definitely be accomplished.
So how does this result happen in the first place? Well, it has everything to do with the techniques that are used to reduce a long or projected nose. Take a look at the images below to get a picture of normal nose anatomy.
In the top image, you can see the normal bony and cartilage anatomy of the nose in profile. The picture on the bottom shows the anatomy of the septum inside your nose in relation to the external anatomy. The septum, shown in white, makes up the foundation for the middle part of your nose (the upper lateral cartilages) and, to some extent, your tip as well. It is a large block of cartilage and bone that sits on the upper jaw and provides some nasal stability. The bone to which it attaches along the floor of your nose is called the maxillary crest, and the very front of this bone is a projection called the nasal spine, shown in blue. You can normally feel this as a hard piece of bone at the base of your columella. These are important structures that we’ll tell you about next.
So how is it that some rhinoplasties have such problematic outcomes? Many surgeons, shorten a long nose by removing the nasal spine and the front part of the septum. See the image below for details.
On the other hand, when we want to shorten a nose or rotate the tip, we focus on altering the shape of the tip cartilages themselves to create the contour we want. In this way we are able to provide a predictable result that does not weaken your nose (if anything, it makes it stronger).
Seen above are the cutting methods used by many surgeons to shorten a long nose. This is a bit like shortening a building by knocking out the foundation. The structure sinks, and not in a good way. When the nasal spine or septum are shortened many patients have an acceptable result for the first year, but they are highly unpredictable and often do not last the test of time. They depend on scar tissue build-up to determine the movement and the ultimate shape of your nose. When the foundation is removed, your tip might fall forwards and droop or it might fall backwards and look too short and upturned but, either way, there is a good chance it will collapse and lose refinement over several years.
Why do some surgeons do this?? That’s a good question that we don’t know the answer to. However, most likely, it’s because cutting is quicker and easier than the methods of reshaping the nose and tip to achieve lasting predictable deprojection and rotation. These more reliable techniques are also more difficult to perform, especially through a closed approach. And, since many of the problems that arise from these cutting techniques may not be seen for several years after rhinoplasty, many surgeons may not even realize their patients are having these problems.
So, how do we fix this problem? These revisions are often complicated by virtue of the scar tissue that must be removed to gain the needed length. We then have to restore the cartilage that was lost using grafts known as septal extension grafts and/or extended spreader grafts. Sometimes, a tip graft is used to achieve added length and projection. The good news is that a balanced profile can be achieved, the nose can be lengthened and you can be made happy again.
Above is a Before and After Rhinoplasty photo of a patient who had revision rhinoplasty surgery at Profiles Beverly Hills by Los Angeles Rhinoplasty Surgeons Drs. Peyman Solieman and Dr. Jason Litner. Note the overshortened, overrotated, undefined, and scooped appearance on the left and the restoration of an harmonious and natural profile after surgery. For more information on other rhinoplasty mistakes, visit our dedicated rhinoplasty site.No comments