Can The Midface Be Vertically Shortened?
Q: Dr. Eppley, I wanted to know what the options are regarding shortening the nose and midface. I have yet to see actual nasal shortening described anywhere, rather people focus on tip manipulation for the illusory appearance of a truncated nose, or altering radix position. Post-op from a lefort 1 with counter clockwise rotation or impaction (during which the skeletal housing for the nose would be shortened which begs the question, what happens to the cartilage afterwards?) could a “slice” of the soft tissue nose be excised? Skin, cartilage, and septum. Following this, the nose is then simply adjusted up (the entire structure would slide up) and sutured back together. If there was no excessive gum show prior to the Lefort 1, this would accomplish shortening the nose and midface without inducing any inappropriate levels of tooth/gum exposure. Patient would be left with a small external scar across their nose.
If this cannot be done, may I ask why? I can only imagine the limiting factor to be blood supply and not wanting a major risk of necrosis, but could the entry point be strategically placed to avoid this? Or perhaps lifting or stretching the artery to gain access without traumatizing it?
Any help is greatly appreciated.
A: You are asking a classic midface shortening question for which, short of a LeFort I impaction in vertically maxillary excess (which really only shortens tooth show) or a subnasal lip lift (which only shortens the upper lip), there are no other effective procedures for doing so. You are understandably viewing external midface shortening as a structural/geometric exercise…which it is not. The midface soft tissues are not going to shrink or become less so with any underlying vertical structural reduction.
Dr. Barry Eppley