Will A Septoplasty Bring Down A High Alar Rim?

Q: Dr. Eppley, I feel that addressing the visible septum in left nostril and the rightward curve in the lower third of my nose will go a long way in improving my facial symmetry.  Based on what happens when I push the septum into a central alignment, I think that the septoplasty will help to lower the right nostril which is being pushed up and to the right by the deviated septum.

While my understanding of the basics of a septoplasty are pretty clear, I have a few questions. First, do you typically perform these as an open or closed procedure? Second, do you anticipate that the straightening of the septum could result in a shortening of the nose? I am currently bothered by the tip of my nose sometimes rotating up and showing more nostril. I have read that an upward tip rotation is sometimes a complication of septoplasty and was wondering if there are ways to help prevent this.  

Lastly, is there a way to very slightly lower the effective alar rim height or alar arch to reduce nostril show through the septoplasty (in other words, besides a separate complicated grafting procedure)? Is there a way to increase the length of the septum to slightly rotate the tip forward/down?  Below is an example of how much improvement even a mm or two of alar arch reduction provides.

A: In news to your septoplasty questions:

1) While a septoplasty will reduce the appearance of it into the left nostril, it would be a procedure that I would expect to lower the right nostril rim. As I have never seen an isolated septoplasty make that happen nor can I envision the anatomic reasons why it would.

2) All isolated septoplasty procedures are performed closed.

3) Straightening the septum would not make a nose appear shorter per se. Expecting that outcome is the same as that of it being capable of lowering a high alar rim.

4) I am not aware of ever seeing an isolated septoplasty create nasal tip rotation nor would there be a anatomic explanation for that effect. When septal shortenng is performed at the same time as other tip procedures with the specific intent of tip rotation it has a useful role at that time.

5) Lowering an alar rim requires placement of a graft to do so since this really represents a tissue ‘defect’. If done using a closed approach a chondrocutaneous ear graft is needed. If part of an open rhinoplasty a cartilage alar rim graft Is used.

Dr. Barry Eppley

Indianapolis, Indiana