Rhinoplasty for Droopy Nose in Thick-Skinned Male Patient

Nose Job for Drooping and Wide Nose Tip

A male patient complaining of nasal tip sagging and nasal congestion following a previous nasal trauma applied for treatment. As a result of the patient's examination, the following were detected in the patient:

- septum deviation to the left

- insufficient nasal tip cartilage support and drooping nasal tip

- retracted columella

- bilateral nasal valve stenosis

- right inferior turbinate hypertrophy

We performed micromotor-assisted septorhinoplasty + inferior turbinate reduction operations on the patient under general anesthesia.

Operation note: The operation was started under general anesthesia. After the columellar incision, we made the skin thinner by bilevel skin dissection and underskin tissue removal. Septoplasty was performed and cartilage support behind the columella was provided with the tongue in groove technique using cartilages taken from the septum. Bilateral alar cephalic resection was performed. Alar dome stiches were placed. Bilateral marginal rim grafts were placed. Limited reduction was performed on the nasal hump with a micromotor. Bilateral osteotomies were performed with an ultrasonic device. The skin was laid back and the columella was sutured. Bilateral alarplasty (alar cephalic resection) was performed. Bleeding control was performed and then internal silicone splints and a nasal bandage were placed and the operation was terminated.

In the patient I am sharing with you here, retraction is seen in the columella because the cartilage support at the tip of the nose is very weak. Since the cartilage support of the patient's nose tip is restructured and strengthened, when viewed from the side, retraction in the columella is also eliminated and the nasolabial angle between the upper lip and the tip of the nose becomes normal. It can be noticed in the pre-operative images that there is asymmetry between the patient's nostrils and that they are in a horizontal ellipsoid shape and prone to collapse. Thanks to the simultaneous restoration of the patient's nose tip support and the placement of cartilage grafts on the wings of the nose, the nostrils have become more natural and vertical ellipsoid shape. Due to the wide appearance of the patient's nostrils, alar plasty, i.e. alar base resection on both sides, was performed. The widespread fat holes, i.e. comedones, at the tip of the nose of this patient already indicate that he has a very thick skin and a wounded skin structure before the surgery.

The image above shows pre- and post-operative side nasal photos. The patient's nose tip was directed upwards, along with a limited amount of nasal hump reduction. The threads seen on the side stabilize the camouflage grafts placed under the skin. One week later, those suture materials will be cut in the office after the bandage is removed.

In the image above, pre- and post-operative photos of the nose are seen from below. It can be seen that the shape of the patient's nostrils has become much more natural, and the natural triangular male nose shape has emerged at the tip of the nose.

Because the patient's nose tip is drooping, when viewed from the side it looks as if his nose is arched. In fact, due to the drooping nose tip and the loss of nose tip projection, the bridge of the nose has become more prominent when viewed from the side. Since the aim was to perform a natural male nose aesthetic, when the patient's nose tip was lifted, a very small amount of reduction was needed in the nasal hump, and a male nose shape that looks quite natural when viewed from the side was obtained.

Search result link where you can find articles prepared by Dr. Murat Enoz about droopy nose tip and published on this website (you can also reach previous articles by clicking "more posts" at the end of the page) >> https://www.ent-istanbul.com/search?q=droopy+nose+tip

Murat Enoz, MD, Otorhinolaryngology, Head and Neck Surgeon

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