Can The Vertical Height of the Anterior Nasal Spine Be Reduced To Decrease The Total Nose Height?

Q: Dr. Eppley, I want to reduce   he “vertical height” of the anterior nasal spine, which is what I was asking if could be reduced/shaved from the bottom. This would help reduce the total nose height of the face.However, this might reduce the bone support for the Nasal Columella. To which I proposed if, a bone graft or cartilage could be used on the top of the anterior nasal spine, hence increasing its vertical length again but this time on the top. And then a rhinoplasty is performed. In this way, theoretically, the nasal height was changed but the bone support and the nose shape etc are still ideal. This surgery also in turn could help us in improving other craniofacial measurements like the length of midface (this theoretical reduction of nose height will increase philtrum height which we can again decrease with a lip lift thus reducing the midface length).

I just wanted you to ask you if this is possibly even THEORETICALLY, I’m aware that no surgeons have ever done it officially.

A:Thank you for your clarification on your surgical objectives. I don’t think the question is whether such an operation can be technically done as it is fairly straightforward as you have illustrated despite the fact that it probably has never been done in exactly the way you have described. My concern would not be whether it can technically be performed but whether in so doing the aesthetic outcome is exactly what you think it may be. The problem is you’re making a lot of assumptions about the aesthetic outcome based on drawing on a skeletal model. That is often a flawed concept as what happens at the bone level does not always translate to the outward aesthetic effect. One major consideration is that if the objective is to reduce mid facial length that is simply never going to happen no matter what you do at the bone level. Everyone fails to factor in to what happens to all the overlying soft tissue no matter what you do to the bone… It does not go away and thus external mid facial length is never really changed. The only effective mid facial length reducing procedures are sub nasal lip lift and reductive rhinoplasties that are associated with increased tip rotation. Nothing you can do at the bone level is ever going to decrease external midfacial length.

Dr. Barry Eppley

World-Renowned Plastic Surgeon