Secondary Rhinoplasty for Upturned Nose

Q: Dr. Eppley, I would like to know how to get information about secondary rhinoplasty with Dr Eppley. I have seen some approaches to correct upturned noses, and I am interested in knowing the options Dr Eppley offers.

A: Thank you for sending your pictures, x-rays and a very detailed description of your surgical history particularly as it relates to your prior rhinoplasty. Your prior nasal concern, and the most difficult challenge to correct, is that of the over rotated nasal tip. There are two fundamental approaches to driving down the tip of the nose, 1) stack caritlage grafts on the infralobular side of the tip while reducing tip length (push the tip skin down using the existing nasal cartilage as the floor) or 2) place an interpositional graft between the septum and the nasal tip to push it down from behind it. Each approach has its merits but with either technique the key is having good cartilage with enough rigidity to create the effect. I will assume that your septal cartilage has been harvested for the original rhinoplasty as well as having one ear harvested as well. This limits your cartilage donor options to either rib cartilage or cadaveric cartilage.

Dr. Barry Eppley

Indianapolis, Indiana