Wide-Open Dorsal Approach Rhinoplasty for Droopy Noses

Overview

Standard rhinoplasty reshapes the bone and cartilage under the skin, which works poorly when the skin itself is thick and the nasal tip hangs low. In those noses excess skin has to be removed anyway. The authors describe doing the whole operation through the resulting dorsal skin window, avoiding the usual incision across the columella.

Sections of note

• Nine male patients with thick skin and markedly drooping noses had the wide-open dorsal approach.
• Mean age 51.4 years, mean follow-up 20.6 months.
• Appearance rated by patients on a visual analogue scale rose from 23.3 to 92.6.
• Nasal Obstruction Symptom Evaluation scores fell from 79.5 to 11.5, indicating easier breathing.
• Nasolabial angle rose from 72.9 degrees before surgery to 92 degrees at three months and 91 degrees at twelve months.
• In the four patients followed to 24 months the angle dropped less than 2 degrees from the three-month measurement. Mean dorsal scar score was 4.1 out of 5.

What it means for a patient

• The technique is aimed at a narrow group: older patients with thick skin and a strongly drooping tip, where excess skin must be removed.
• It trades a scar on the bridge of the nose for the ability to remove that skin and reach the framework in one step.
• The scar scored well on a standard scale, but a visible dorsal scar remains the main trade-off.
• Only nine patients, one centre, no comparison group and only four followed to two years, so these results are preliminary.

Why this paper matters

Thick-skinned drooping noses are a recognised weak point of conventional rhinoplasty, where the skin envelope refuses to redrape over a reshaped framework. This paper offers one answer for selected older patients. Whether the dorsal scar is acceptable to a wider population, and how the correction holds past two years, is unanswered.

Terms

• Nasal dorsum: the bridge of the nose, running from between the eyes to the tip.
• Ptotic or droopy nose: a nose whose tip points downward.
• Transcolumellar incision: the small cut across the strip of skin between the nostrils used in open rhinoplasty.
• Nasolabial angle: the angle between the base of the nose and the upper lip, a measure of tip rotation.
• Nasal Obstruction Symptom Evaluation: a short questionnaire scoring how blocked the nose feels.