What can be done to treat an upturned, over-shortened nose with a pollybeak deformity that resulted from a prior Rhinoplasty?
I have written about the upturned or over-rotated nose a few times in the past. It's one of the more complex problems we encounter in rhinoplasty surgery. I discussed fixing a congenitally short, upturned nose here and a post-rhinoplasty over-rotated nose with pollybeak deformity here. Today I'd like to talk about another patient who came to me with an iatrogenic (caused by prior surgery) upturned, foreshortened nose.
Over-Rotated Nose Case Study
This gentleman had a rhinoplasty with a different surgeon to remove a dorsal hump about 6 months before coming in to see me. He was unhappy with how upturned his nose had become since having surgery. Additionally, his bridge appears over-resected, especially at his radix (the upper portion of his bridge between his eyes). This results in a pollybeak appearance with a persistently full supratip.
Pig Snout Effect
Not only does his nose look less masculine as a result but it leads to what some call a pig snout effect due to the fact everyone is looking up into his nostrils on frontal view
Derotating and lenghtening the nose
Using an open revision rhinoplasty approach I was able to address all of these issues. Cartilage grafts were taken from the patient's septum and ear to allow me to create a strong, stable nasal framework. A caudal septal extension graft was placed to help lengthen the nose and counter-rotate the tip. The after profile photo below shows how I was able to create a more masculine, natural appearance by bring the nasal tip down to a less rotated position. I placed a cartilage radix graft to build up the nasal bridge height where it was over-resected.
On frontal view you can see how much more natural the tip appears now that we aren't looking so directly up the patient's nostrils. He also has a much better nasal sidewall appearance now that I was able to fully narrow his nasal bones with revision osteotomies.
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