Q: Dr. Eppley, My rhinoplasty is tricky as my stiff columella is my main complaint. wonder if the actual columella bone can be shaved without addressing the tip of the nose. I have read about anterior nasal spine reduction but I am not sure what that is. I am open to suggestion.
A: The reason that your columella is so stiff is that you have a prominent anterior nasal spine. This is what you refer to as the ‘columellar bone’. The end of the nasal septum, which sits behind the columella of the nose, rests on the anterior nasal spine. The longer and more prominent the anterior nasal spine is on the maxillary bone, the more forward will sit the end of the septum. This causes a very open nasolabial angle (angle between the base of the nose and the upper lip which inn most men should be about 90 to 95 degrees) and a very firm and stiff feeling columella. The anterior nasal spine reduction procedure removes the bony prominence and the base of the end of the cartilaginois septum that attaches to it will allow the nasolabial angle to sit back, decreasing the tension on the columella and the upper lip. This can be done by itself or one of the many maneuvers in an overall rhinoplasty procedure.
Dr. Barry Eppley
Q: Dr. Eppley, Have you ever heard of ANS reduction in conjunction with Maxillary advancement (i.e. jaw surgery). My surgeon is proposing this but has been vague about the aesthetic and functional effects. From what I have read, it makes the nasolabial angle more obtuse. Would this mean removing the ANS results in longer upper lip and turned up nose? He is also advancing the upper jaw 3.5mm and rotating it ccw 3mm. Finally, would removing ANS during surgery preclude me from a future nose job should I need one? Thank you!
A: I not only have heard of ANS reduction with LeFort osteotomies but have done that many times in conjunction with them. The reason ANS reduction may be done in large maxillary advancements is that it may cause the tip of the nose to rotate upward or, at the least, widely open up the nasolabial angle. Removing it would prevent that concern. Whether removing the ANS is necessary in just a 4mm maxillary advancement, however, is different as it may not really be needed if the total bony movement is simple forward. But if there is any upward rotation of the upper jaw it would be needed. I would trust your surgeon in that decision. But whether it is removed or not, it does not preclude or maake difficult any future rhinoplasty efforts.
Dr. Barry Eppley
Q: I am unhappy with the shape and length of my upper lip. It bulges out right under my nose. I would like to meet with a Doctor who has experience with lip lift surgery to see if my upper lip could be made to look better and to get rid of the bulge right under my nose. Here are some pictures of my face. My wife took the pictures and we were trying to show how my upper lip bulges out in the middle under my nose. All I want is to have the bulge removed or maybe even have it to where my lip would be more concave right under my nose. I really don’t even care if my lip is lifted or made shorter, just as long as the bulge is gone and made smooth or even hollowed out some. Thank You.
A: Thank you for your inquiry and sending the pictures. They illustrate well the bulge underneath your columellar area of the nose in the upper lip area. Interestingly that bulge is likely not just excess lip tissue alone. Undoubtably your anterior nasal spine is excessive in length and size as well. You may not be familiar with this small area of nasal bone that juts out undereneath the base of the nose. I have attached some anatomy pictures of where it is, and when it is excessively long in combination with the front of the nasal septum, how it can contribute to an upper lip bulge. I suspect that this small piece of bone and cartilage is making some contribution to that bulge along with some excessive lip soft tissue. That can be immediately confirmed by simply feeling under the upper lip as well as pushing down on the bulge at the same time.
Therefore, I would propose that he best solution for your upper lip bulge is a combination of a modified lip lift (use the incision to remove some soft tissue and muscle underneath bulge and only do a 2 -3 mm lift) and an anterior nasal spine resection. Anterior nasal spine reductions are commonly done in rhinoplasty surgery so its effects and benefits are well known.
Dr. Barry Eppley