Tips & Tricks of Secondary Short Nose Correction

Short nose means too much nostril show as well as short length of nose. So the correction must aim at not just lengthening of the nose but also reducing too much visible nostril floor. Short nose correction is one of the most prestigious and high-level techniques in Asian rhinoplasty.

I. Introduction

Contracted short nose comes from the infection, multiple operations and sometimes merely from the patients’ idiosyncratic physical character, even though they did not have multiple surgeries nor any infection.

This presentation will cover both surgical technique of the contracted short nose correction and some tips & tricks to improve the result of secondary short noses.

II. Surgical Techniques

Basic technique of the release, repositioning and fixation of lower lateral cartilages (LLCs) are same as primary short nose correction. Lower lateral cartilage should be released from the scroll area, hinge complex and membranous septum. To maintain and fix the released LLCs, one of the following techniques can be applied: septal extension graft, derotation graft.

Septal extension graft is the most preferred and the most frequently performed technique for the short nose.

Septal extension graft

Derotation graft is another technique for the fixation of lengthened LLCs. This technique uses the conchal cartilage for the fixation of the LLCs. This technique gives more movable and soft nasal tip, compared to the septal extension graft.

Derotation graft

Tips and tricks to improve the result of secondary contracted short nose

Contracted nose correction is considered to be challenging to the surgeon, because of the much scar tissue around the LLCs and under the skin envelope.

For the greater release and lengthening of the skin envelope, wide dissection of the soft tissue envelope beyond the pyriform aperture is recommended and dual plane dissection of the scar tissue(capsule) from the underlying framework and the overlying skin envelope is required.

Dual plane dissection in the contracted short nose correction

To avoid the rigid, fixed nasal tip from septal extension graft, derotation graft can be a very useful alternative technique. This technique allows soft movable nasal tip while avoiding witched tip when smiling.

Dermis or dermofat graft will be sometimes needed to correct the irregularity of nasal skin envelope or shrink contracted appearance of nasal dorsal skin.

In case of collapsed septum, L-strut reconstruction is mandatory to achieve the stable long-standing result.

L-strut reconstruction using rib cartilage

Author: Man Koon Suh, M.D.