Lengthening a Short Nose

This young lady from outside of San Diego, CA desired to have a revision rhinoplasty following prior surgery by another plastic surgeon. Her main concern was in the region of the nasal tip where she thought her tip was too ‘piggy’ or turned up. Some people refer to this type of nose as also being too short since it is lacking proper length as measured from between the eyes down to the nasal tip. Others simply say they don’t like how much of the nostril opening they can see – also called excess nostril show by rhinoplasty surgeons. In addition, she was unhappy with the asymmetry between the two sides of her nasal tip. Furthermore, she felt as if her nasal tip stuck out too far from the plane of her face – a condition we call over-projection of the nasal tip.

Lengthening the Short Nose

She took the effort to drive to San Diego to consult with Dr. Hilinski given his nationwide reputation as being one of the best revision rhinoplasty experts around. Her skin was classified as being a bit thicker – consistent with her ethnic background and not too different from many of Dr. Hilinski’s ethnic rhinoplasty patients. Fortunately, her skin was considered amenable to making the desired changes to lengthen the overall shape of the nose – while also deprojecting the tip (bringing it back closer to the face).

An open rhinoplasty approach was chosen because it offered Dr. Hilinski maximum exposure to reshape the cartilage while doing very precise cartilage grafting. Fortunately for her, there was a sufficient amount of septal cartilage still in her nose that precluded having to look elsewhere for a source of cartilage grafting.

Her actual rhinoplasty diagram is shown here, which is a common way for rhinoplasty specialists to show more diagrammatically what specific maneuvers were performed during the surgery. In her case, this included:

• Reduction of her bridge height
• Breaking of the nasal bones (osteotomies)
• Septal cartilage harvesting for grafting purposes
• Complete tip reshaping including grafting
• Placement of a caudal septal extension graft

The last maneuver on the list, placement of a caudal septal extension graft, is a powerful tool for some rhinoplasty experts that is key in helping to lengthen a nose. This is indicated in the diagram as CSE. In concept, a caudal extension graft is a piece of cartilage that is carefully sewn to the native septum so that it extends out toward the upper lip. In doing so, it allows the rhinoplasty surgeon to move the nasal tip down into a new position. Essentially, this adds desired and needed length to the nose and helps correct the short (pig) nose deformity.

Short Nose Correction

Here are her actual before and after photos showing an overall stable cosmetic improvement in the nose. As you can readily see, her nose has been lengthened very nicely thanks to the use of the caudal septal extension graft. The tip grafting gave her a beautiful new, more symmetrical nasal tip shape. This can even be appreciated on the oblique (45 degree angle) view where her tip no longer appears as irregular. You will also note how there is much less nostril show following the revision rhinoplasty. And on the side view, you can see how her tip has been lengthened as well as deprojected.