Can an upturned nose be fixed?

Short nose or upturned nose correction is often considered as the most difficult kind of rhinoplasty. Majority of upturned nose corrections are revision surgeries, as the most of cases are caused by a botched or excessive surgery. Only the small part of surgeries are primary operations, when the short nose deformity is caused by genetics or accidents. In this post we will introduce possible causes of, so called “piggy nose”, condition and effective ways to correct it.

Causes of nose contraction

Upturned nose might be caused by genetic, post-accidental and postsurgical deformities. The later is a reason of majority of cases.

  • Genetic – if someone is born with contracted nose, the cause lies in ones genetic, such as in many other cases of inborn nose deformities. Inborn upturned nose is usually not a symptom of any hereditary disease and is also the easiest to correct.
  • Post-accidental – if the nose is an object of a huge trauma it may end up with a permanent deviation. Such injury is caused by a strong frontal blow. The nose might be a subject of it when someone falls down on the face, has a car collision, accident when performing sports or is punched during the fight.  
  • Postsurgical – majority of contracted nose cases are secondary short nose deformities – the nose becomes upturned due to botched surgery or excessive operations, or both combined. Postsurgical nose contraction mostly happens when:
    • Nose skin, soft tissues and cartilages are objects of trauma due to repetitive surgeries
    • Too much amount of cartilage is removed
    • Nasal implant puts too much pressure on a lower cartilage causing its necrosis
    • Materials used for augmentation are unproven or not suitable for the patient – rejection, allergic reaction or cartilage erosion (e.g. when PCL soft mesh is used).

Deformations originated in mishandled or excessive surgeries are the most difficult to correct. What makes secondary short nose correction so complicated is the character of the malformation itself. When performing this operation, the surgeon must consider two inseparable conditions for successful and satisfying operation: the nose must be made longer and, at the same time, visible nostrils must be corrected. To achieve successful result the surgeon must have a lot of experience in revision rhinoplasty.

Techniques of short nose correction

The technique of short nose correction is chosen concerning the seriousness of the case. If the nose is just slightly angled upward and nostrils are not overexposed, the operation with usage of ear or septal cartilage to make the tip longer is enough. Such case often occurs for naturally short nose, so it is also not necessarily a revision surgery.

A case of mildly upturned nose and correction result

If the nose is seriously upturned and the nostrils are prominent, the surgeon must perform a much more complicated operation. There are couple of ways surgeons use in such cases.

Seriously upturned nose and the result of correction

Basic technique of the release is repositioning and fixation of lower lateral cartilages (LLCs).

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 (1) is the most preferred and the most frequently performed technique for the short nose.

Derotation graft (2) is another technique for the fixation of lengthened LLCs. This technique uses the ear cartilage for the fixation of the LLCs. Comparing to septal cartilage graft this technique gives softer and more movable tip.

The third technique is hybrid cartilage graft (3). This technique is used when the patient has extremely small amount of septal cartilage and hybrid of septal cartilage, ear cartilage and rib cartilage must be used.

Dr. Suh Man Koon expertise in short nose correction surgery.

Dr. Suh Man Koon – JW Plastic Surgery director and rhinoplasty specialist is known for his expertise in short nose surgery and revision rhinoplasty. He published many articles about revision short nose correction and revision rhinoplasty in top academic journals, such as Annals of Plastic Surgery, The Journal of Cranofacial Surgery, Aesthetic Plastic Surgery and many more.

Recently Dr. Suh’s proficiency in short nose correction has been recognized by ISAPS (International Society of Aesthetic Plastic Surgery). Dr. Suh will present and discuss Tips & Tricks for Secondary Short Nose Correction during ISAPS Virtual Olympiad on September 5th this year. He will present there as one of the Top 50 Experts from 5 continents.

We have published a hint to Dr. Suh’s presentation before: LINK

Derotation graft – upturned nose correction LIVE surgery.

The video was shoot during the upturned nose revision surgery using derotation graft technique -performed by Dr. Suh Man Koon.

Correction of contracted short nose combined with retracted alar is being performed using derotation graft with ear cartilage and composite graft (skin plus cartilage) harvested from triangular fossa of ear. This technique enables dramatic correction of upturned tip and retracted alar while maintaining soft movable nasal tip and avoiding rigid, fixed tip.