Structure rhinoplasty of the long nose

Overview

A long nose can come from a septum that reaches too far down toward the lip, tip cartilages that have slipped downward, a hump that adds height, or a shallow angle between forehead and nose that makes the nose look longer than it is. The authors present a multicenter experience treating the long nose by correcting these three-dimensional structures rather than by simply cutting tissue out.

Sections of note

• 138 patients at three centers, all with a complaint of a long nose.
• Causes listed: long septum invading the lip, downward dislocation of the alar cartilages from the septal angle, a dorsal hump creating an illusion of length, and an absent or shallow frontonasal angle.
• Approach: structure rhinoplasty addressing the contributing anatomy, instead of traditional excisional techniques.
• Recreating a straight dorsum and a normal frontonasal angle is described as dynamically shortening the nose.
• Shortening achieved in 122 of 138 patients (88.4%) on objective and subjective evaluation.
• The abstract does not state follow-up length or complication counts.

What it means for a patient

• A nose that looks too long may be fixed partly by lowering a hump and deepening the angle at the root, not only by shortening the tip.
• About 9 in 10 patients in this series were judged shorter and better looking afterward.
• The evaluation methods and follow-up period are not given in the abstract, and there was no comparison with excisional techniques.

Why this paper matters

The long nose is a common complaint and its causes are several. This paper applies the structural philosophy, which preserves and repositions support, to that problem. How the 16 patients without adequate shortening differed, and long-term stability, are not reported.

Terms

• Long nose: a nose whose length from root to tip is out of proportion to the face.
• Structure rhinoplasty: an approach that preserves or rebuilds the cartilage framework rather than removing it.
• Septal angle: the front lower corner of the septum where the tip cartilages attach.
• Alar cartilages: the paired tip cartilages that shape the nostrils and tip.
• Frontonasal angle: the angle between the forehead and the bridge at the root of the nose.
• Dorsal hump: a bump on the bridge made of bone and cartilage.