Q: Dr. Eppley, I am a 25 year-old man looking for a type of rhinoplasty that will change the appearance of an upturned nose. I have had this nose shape since I was born. It is not only upturned but it is concave across the bridge with excessive columellar show from the very profile view. I am very tall which really accentuates the problem as you can literally look straight up my nose. What type of rhinoplasty do I need to make my nose look more normal and would it make enough of a change to make the operation worthwhile. I can’t seem to find any pictures on the internet of this type of rhinoplasty correction.
A: What you have is a congenitally short nose that sometimes is also called a saddle nose although this is not completely accurate. In a short nose, the length of the nose is diminished from the radix to the tip and is due to an underdeveloped nasal septum. Your description of this nasal type is exactly what one sees from a saddle-shaped bridge to an upturned nasal tip. It actually is not rare and a short nose can also occur from traumatic injuries as well as natural development. The correction of the short nose depends primarily on the use of cartilage grafts along the dorsum and columella to extend its length and direct the tip downward. The end of the septum must be extended as well. This is done though an open rhinoplasty. While cartilage from the septum can serve as the donor source, it is frequently inadequate in the amount and dimensions needed. This is why rib cartilage is frequently used in the lengthening of the short nose.
Dr. Barry Eppley