"How Can Nose Tip Drooping Appear After Septoplasty?" - Turkish Video

Dropped Nasal Tip After Nose Surgery

Areas of curvature in the nose septal cartilage are removed during the deviation operation. Each of the nasal cartilages has its own unique tasks and features.

As seen in the photo during the surgery, it is necessary to protect the lower cartilage area at least 10 mm wide and the upper right cartilage area 10 mm wide (at least 10 mm wide cartilage area in the form of "L"). Apart from this area, the newly corrected cartilage can be inserted from the nebulization site, or it is ideal to leave the larger and larger cartilage area in place (i.e., the primary is the preservative and minimally traumatic operation).

When the tip of the nose is drooping, the resistance of the intranasal airway may increase!

When the tip of the nose is drooping downwards, the nasal valve angle narrows and generally, patients may complain of narrowing in the nasal airway, increased resistance and nasal congestion. After septoplasty, which is a simple functional operation, weakening of the nasal tip support and consequently dropped nose tip may cause both deformity and functional problems in the nose. In other words, during the septoplasty operation, a limited amount of cartilage excision, restructuring of the caudal septum and restructuring of the nasal cartilage support are performed.





If the caudal septum part of the nasal septum, which is one of the most important supporting tissues of the nasal type region (nasal type region), is completely removed, the nasal softens and the caudal septum region, that is, the support of the caudal septum region where the finger tip can be buried upwards as seen in the videor It can be understood that there is no tissue. In this case, with aging, it is easy to notice that the nose tip is moving downward faster than normal, sagging and enlarging at the tip of the nose when laughing, and gradually increasing nasal congestion.

In nose surgeries, the cartilage structure in the nose should be preserved as much as possible, and anatomical changes should be limited as much as possible. With the information I shared with you in this article and as seen in the photos below, the operation should not be terminated without simply resection of the septum, reconstructing the nasal tip with a re-cartilage graft (i.e., placing new cartilage tissue in place of the resected septum piece) in curvatures in the lower part of the nasal septum and the caudal part. If a cartilage tissue is excised and removed, it is ideal to place a new one and shape the nose as close to normal as possible.

In Septal Deviations (Caudal Septum Dislocation) Overflowing into the Nostrils, Septal Resection May Cause Sagging of the Nose Tip!

The lowest part of the nasal septum, that is, just behind the columella and which should normally be felt in the midline, may be siloed to the right or left after direct trauma to the tip of the nose. In this case, which is called anterior septal dislocation or caudal septum deviation, there may be differences between the asymmetry at the tip of the nose and the nostrils. In this way, patients with septum deviation can notice the caudal part of the septum when they lift the tip of their nose with their fingers. In the photo on the left, the patient with a deviation of the caudal septum and the caudal part of the septum can be seen from the left nostril when viewed from below, an open technique rhinoplasty operation was performed and alarplasty operation was performed together to make the nostrils more symmetrical. A flat columellar strut graft was placed in place of the cartilage area removed from the caudal part of the nasal septum at the tip of the patient's nose. In patients who have had a large amount of caudal septal cartilage resection, sometimes larger cartilage grafts (septal extension graft) or tongue-in-groove technique can provide support for the caudal septum again.

Treatment of Dropped Nose Tip - Nose Tip Lifting Procedure

Nose surgery is needed to reconstruct the nasal support tissue by using the remaining septum cartilage, rib cartilage, or ear lug cartilage in patients with prolapse and downward nose after nose operations.

The patient, who has pre- and post-operative images in the photographs below, applied with the complaint of sagging downwards at the tip of the nose after the previous septum deviation correction operation and nasal trauma, and the patient underwent open technique, nose tip lifting operation. Rib cartilages were used for the reconstruction of the nasal tip.

Patients with Over-Resected Nasal Septum Cartilage May Need to Use Rib Cartilage!

Various deformities such as nasal tip sagging and saddle nose deformity have emerged due to various reasons, where the nasal septum cartilage was resected to a great extent (as in patients with severe nasal septum deviation), the patient was not resected and graft was not applied to the area responsible for nasal cartilage support during the operation. It is appropriate to use rib cartilages, which offer a hard and durable cartilage tissue, in patients with rheumatoid arthritis. Auricular cartilage is highly elastic and curved. It can be used to support the nasal wing or in cartilage graft applications for the dorsum of the nose. It is ideal to use rib cartilage, which is harder and more robust, in lifting and supporting the tip of the nose. As rib cartilage, rib cartilage obtained from the patient's own rib or from another human cadaver can be used. The reason why patients want their own rib cartilage to be used is because it is aimed to use the most reliable tissue; The reason why they want to use cadaver rib cartilage can be summarized as they do not want additional incision, anesthesia time and pain. We can discuss this when you meet face to face :).

In patients, the use of additional rib cartilage may increase the total operating cost and prolong the surgical time.

Different Non-surgical Procedures For Nose Tip Lifting in These Patients!

I would like to talk about a few non-surgical nose tip lift procedures that you can think of in patients who have sagging and spreading at the tip of the nose after a nasal surgical procedure.

Nose Thread Lift

In patients with nasal tip drooping due to nasal septum resection and drooping while coughing, the simple thread nose lifting procedure performed under office conditions may not give very effective and long-lasting results. It is very difficult to fix the nose tip support with just a few threads and stitches. In normal patients, the effect of nose thread lifting lasts for 1 or 2 years; This period may be much shorter in patients with weakened nasal tip support. It is a procedure that I do not normally use and prefer. PDO threads are used for this simple procedures. It is only used for temporarily lifting the tip of the nose.

Nose Tip Lifting With Botox

With Botox injection, paralysis of the muscles that pull the tip of the nose down while laughing for 4-6 months can reduce the downward spread at the tip of the nose. However, like the nose thread lifting above, this procedure is not considered an alternative to surgical nsoe tip lifting procedures, as a very limited effect can be achieved in patients with weakened nasal tip support.

Nose Tip Lifting With Filler

Filler injection is a non-surgical nose aesthetic procedure that can be performed in office conditions and can be terminated within a few minutes, just like the above two procedures. It can be used to fill the hollow areas on the nose and to eliminate asymmetries. Generally, filler materials containing hyaluronic acid, which are the most reliable substances, are used and the duration of action is around 10-12 months.

In patients with nasal tip sagging after nasal surgery, a very limited amount of upward orientation can be achieved with nose filler injection, and this effect may disappear in a very short time. As a simple logic, placing a gel-form and gradually softening material instead of a hard cartilage insert cannot provide sufficient support force.

You can access images and detailed information about the nose filler procedure in the links on the left and below. In patients with nasal sagging, if an operation is already planned, it may not be appropriate to waste money and inject a foreign substance into the surgical field.

Link to find detailed information about "Nasal Tip Ptosis After Septoplasty - Nasal Tip Drooping After Septoplasty Operation - Open Technique Nose Tip Lifting - Dropped Tip After a Septoplasty Operation - Droopy Tip Nose Following Nasal Septum Deviation Operation" >> Dropped Nose Tip After Septoplasty

Source links >>

• Multifactorial approaches for correction of the drooping tip of a long nose in East asians - PubMed (nih.gov)
• Approach to the correction of drooping tip: common problems and solutions - PubMed (nih.gov)
• Algorithm for Treatment of the Drooping Nose | Aesthetic Surgery Journal | Oxford Academic (oup.com)

Murat Enoz, MD, Otorhinolaryngology, Head and Neck Surgeon - ENT Doctor in Istanbul

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