Treatment of the Short Nose(Overturned Nose)
The short nose deformity is a very common problem that is seen following a primary rhinoplasty, which results from overaggressive primary rhinoplasty procedures that result in excessively overturned noses that aesthetically look extremely displeasing to the patient. Furthermore, many Asian-Americans will also have significantly short noses that are a normal anatomic variation. The nasolabial angle, which is the angle between the upper lip and nose is typically 95 to 105 degrees for women and 90 to 95 degrees for men.
The patient’s height needs to be taken into consideration when the nose is being analyzed as someone who is very short can tolerate a slightly more overturned nose than someone who is extremely tall. A tall individual with a very overturned nose will have an extremely poor aesthetics, as anyone who is at their level will see into the nostrils very easily. These are extremely important aspects of the nasal analysis as not only does the nose need to be analyzed in relation to the face, but furthermore needs to be analyzed with patient’s ethnicity, body, height and shape as well.
The treatment of the overturned nose is perhaps one of the most challenging components of primary (ethnic) or revision rhinoplasty procedure. Typically, multiple cartilage grafts are required to reverse the overturned short nose to create better aesthetics. Oftentimes this will require harvesting of rib graft to obtain the necessarily structural support that is going to be required for lengthening the nasal tip as well as reducing the upturn of the nose.
An external/open rhinoplasty approach is utilized to identify the cartilages of the nasal tip and the middle nasal vault, which is the middle portion of the nose. Cartilage tip grafts and extended spreader grafts are utilized to counter rotate the nose and lengthen the nose. Oftentimes, the patient will require fascia, which is soft tissue covering, to allow beautiful and aesthetically pleasing tip in addition to counter rotation of the nose.