Droopy Nose Aesthetic Before and One Week After Photos

Rhinoplasty For Sagging Nose in Female Thick Skinned Patient

Two separate images of our patient are shown: one taken before the operation and the other one week after the rhinoplasty. The patient now has a nose that is more proportionate to their face. Although the discoloration under the eyes will fade within a few days, the nose still appears edematous.

Upon examination of the patient who reported a history of childhood nasal trauma and presented with a drooping, asymmetric nasal tip and nasal obstruction the following findings were noted:

- drooping nasal tip with reduced cartilaginous support

- caudal septum dislocated into the left nostril (anterior septal dislocation/caudal septal deviation)

- thick nasal skin

- S-shaped septal deviation

- hypertrophy of the right inferior turbinate

- asymmetric bony hump

- nostril asymmetry

- nasal valve collapse (more pronounced on the left)

An open-technique septorhinoplasty and limited turbinate reduction via radiofrequency were planned.

During the operation, the dislocated caudal septum was partially resected. The dome points of the alar cartilages were repositioned, and alar cephalic resection was performed. A septal extension graft, a cap graft, and marginal rim grafts—prepared from septal cartilage—were placed and sutured. Hump reduction and bilateral osteotomies were performed using ultrasonic and micro-drill assistance; an additional external osteotomy was also carried out. Right alar base resection was performed. The skin incision was sutured, and the operation concluded with nasal taping and splint placement. Photos taken pre-operatively, immediately post-operatively, and one week post-operatively are provided below.

Our patient had almond-shaped eyes and an Asian facial structure. Therefore, the reduction of the nasal hump was limited in extent to avoid creating a "flat nose" appearance.

In this article, we shared information about our patient, who had very thick nasal skin, so we performed a two-level subcutaneous dissection and removal of subcutaneous tissue during surgery. We recommended that the patient take Zoretanin tablets after the surgery to slow down the production of aggressive fibroadhesive tissue. Taping techniques were developed for the patient, and salt restriction and other medical treatments were recommended.

A drooping nasal tip can be a significant aesthetic factor when evaluating the nasal profile and the overall appearance of the face. A forward and downward positioning of the nasal tip can make the nose appear longer than it actually is or disproportionate to the rest of the face in some individuals. This characteristic may be particularly noticeable in the profile view.

The goal of correcting a drooping nasal tip is to reposition it so that it harmonizes better with the other anatomical features of the face. To achieve this, the existing cartilage structure of the nasal tip, the septum, the nasal bridge, the nasolabial angle, and the overall facial proportions are evaluated collectively. Surgical planning focuses not merely on lifting the nasal tip, but on achieving a natural result that is consistent with the nose's overall structure.

What Causes a Drooping Nasal Tip?

A droopy nasal tip, or a downward-oriented nasal tip, can arise from the interrelationship of the cartilages and soft tissues that constitute nasal anatomy. The position of the nasal tip depends on more than just the shape of the tip cartilages; the length and position of the septum, the structure of the lower lateral cartilages, the characteristics of the nasal base, tip support mechanisms, and the angle between the nose and the upper lip can all influence the appearance of the nasal tip. Consequently, a droopy nasal tip appearance that looks similar from the outside may stem from different underlying anatomical causes.

In some individuals, the nasal tip is structurally positioned lower. Specifically, the shape and orientation of the cartilages forming the nasal tip can cause it to point downwards. In such individuals, the droopy position of the nasal tip is more noticeably apparent in profile view. The relationship between nasal tip projection and rotation is also significant; the tip may project sufficiently forward yet still be oriented downwards, or it may exhibit both a droopy position and insufficient projection. The surgical approach for these two scenarios may differ.

The Influence of the Septum on the Nasal Tip

The septum is a key structure influencing the position of the nasal tip. In particular, the length and position of the anterior and caudal sections of the septum play a vital role in supporting the nasal tip. The position and length of the caudal septum relative to the nasal tip can affect tip rotation and the nasolabial angle. In some patients, the anatomical relationship between the septum and the nasal tip cartilages may contribute to a downward orientation of the tip.

Therefore, examining only the external appearance is insufficient when evaluating a patient presenting with a complaint of a droopy nasal tip. The structure of the septum, the intranasal airway, the nasal tip support mechanisms, and the mobility of the nasal tip must be evaluated collectively. Surgical planning requires greater detail, particularly in patients who have previously undergone nasal surgery, as the structure of the septum and nasal tip cartilages may have been altered.

Structure of the Nasal Tip Cartilages

The lower lateral cartilages are among the primary structures determining the shape of the nasal tip. The length, width, thickness, and curvature of these cartilages, as well as their relationship to one another, can influence the appearance of the nasal tip. If the cartilages are oriented downwards or fail to provide adequate support, the nasal tip may appear droopy or downturned.

Additionally, asymmetry between the cartilages on either side of the nasal tip can lead to an asymmetrical appearance. If the cartilage on one side is longer, more curved, or positioned at a different angle, the nasal tip may appear not only droopy but also asymmetrical, leaning toward the right or left. In such cases, both the height and symmetry of the nasal tip must be considered during surgical planning.

The Effect of Aging on the Nasal Tip

Changes occur in the nasal skin and soft tissues as one ages. Alterations in the elastic properties of the cartilage, the loosening of soft tissues, and the gradual weakening of the structures supporting the nasal tip can cause the tip to appear lower. Consequently, nasal tip drooping which may not have been apparent in youth can become more noticeable in later years.

Age-related changes affect not only the position of the nasal tip but also the appearance of the nasal bridge and surrounding facial structures. Therefore, when evaluating a patient for rhinoplasty at an older age, the overall proportions of the face and nasal function must be considered alongside the lifting of the nasal tip.

Downward Movement of the Nasal Tip When Smiling

In some individuals, the nasal tip may appear to be in a normal position while at rest but move downward during smiling. This condition can be classified as dynamic nasal tip ptosis. The movement of muscles around the upper lip and the base of the nose during smiling can temporarily alter the position of the nasal tip.

For this reason, examining only photographs taken while the patient is at rest may not be sufficient when evaluating the nasal tip; how the tip moves during smiling must also be assessed. The approach taken for dynamic nasal tip ptosis may differ from that used for structural nasal tip ptosis that is evident while at rest.

Trauma-Induced Nasal Tip Droop

Nasal trauma can cause the nasal tip to shift downward or appear droopy over time. As seen in this patient, the displacement or distortion of the cartilages supporting the nasal tip, the caudal septum, or the structural supports along the nasal bridge—resulting from trauma—can alter the nasal tip's normal anatomical position. While post-traumatic edema and soft-tissue changes may initially cause a temporary deformity, permanent deformities in the cartilaginous and bony structures can become more pronounced in the long term.

A post-traumatic deviation of the septum can also affect the position of the nasal tip. Specifically, displacement of the caudal septum can compromise the nasal tip's support mechanism, causing it to shift downward, laterally, or in both directions. This may be accompanied by functional and aesthetic issues such as nasal obstruction, deviation of the nasal axis, asymmetry of the nostrils, or irregularities along the nasal bridge.

In some patients, deformities that are not immediately apparent after the trauma may become more noticeable once the healing process is complete. Drooping, asymmetry, or rotational changes in the nasal tip can arise as a result of cartilages reshaping in different directions during healing or the weakening of existing support structures. Therefore, evaluating post-traumatic nasal tip drooping requires examining not only the appearance of the nasal tip itself but also the septum and other supporting structures of the nose.

The treatment for trauma-induced nasal tip drooping varies depending on the cause and severity of the deformity. While limited nasal tip contouring may suffice for mild cases, more pronounced structural deformities may require correction of the septum and structural reinforcement of the nasal tip. Careful assessment of existing cartilage support is crucial, particularly in patients with a history of fractures, septal damage, or prior nasal surgery.

Therefore, a post-traumatic drooping or sagging nasal tip should not be viewed merely as an aesthetic issue. A personalized treatment plan must be formulated by evaluating the nasal tip position alongside the nasal airway, the condition of the septum, the integrity of the nasal cartilages, and overall facial proportions.

Previous Nasal Surgeries

Prior rhinoplasty or septoplasty procedures can also lead to a drooping nasal tip over time. Nasal tip support may diminish due to the excessive removal of supporting cartilage structures, weakening of the septum's supportive section, or improper positioning of existing cartilages during the initial surgery.

Determining the cause of a drooping nasal tip requires a more detailed assessment, especially in revision rhinoplasty patients, as the available cartilage volume may be reduced and scar tissue from previous surgeries may be present. When necessary, cartilage from various sources—such as the septum, ear, or rib—may be utilized to reinforce the nasal tip.

A Drooping Nasal Tip Is Not Evaluated the Same Way for Every Patient

In conclusion, a drooping nasal tip is a condition that does not stem from a single anatomical cause. Cartilage structure, the septum, nasal tip support mechanisms, skin and soft tissue characteristics, age-related changes, dynamic movements during smiling, and previous surgeries can all play a role in this appearance.

Therefore, the goal of nasal tip surgery should not simply be to lift the tip by a few millimeters. A more appropriate approach is to create a personalized surgical plan by holistically evaluating the tip's projection, rotation, symmetry, and relationship with the nasal dorsum, as well as the nasolabial angle and the patient's facial features.

How Is the Nasal Tip Shaped in Drooping Nasal Tip Correction?

The surgical technique employed for nasal tip correction varies according to the patient's specific anatomy. When necessary, the cartilaginous structures supporting the nasal tip can be reshaped, cartilage harvested from the septum can be utilized, or various cartilage support techniques can be applied.

One of the primary objectives of the surgery is to maintain adequate support for the nasal tip. Rather than simply turning the nasal tip upward, evaluating its appearance from both the front and profile views helps achieve a more balanced result.

Before and One Week After Drooping Nasal Tip Correction

The photos in this article compare the patient's appearance specifically the drooping nasal tip before surgery and approximately one week post-operation. Since the one-week photos reflect the early recovery phase, they do not represent the final outcome.

Edema and bruising may occur in the initial days following surgery. Swelling, particularly around the nasal tip, can temporarily alter the tip's true shape and angle. Therefore, it is normal for there to be a difference between the appearance in the early stages and the long-term surgical result.

Changes observed at the one-week mark may provide an early indication of the nasal tip's new position; however, the appearance of the nose continues to evolve over time as tissues heal and swelling subsides.

When Should Rhinoplasty Results Be Evaluated?

The time it takes for the nasal shape to fully settle after rhinoplasty varies from person to person. Factors such as nasal skin thickness, the surgical technique employed, the scope of the procedures performed, and the patient's individual healing characteristics can influence this process.

Consequently, when evaluating photos taken just one week after surgery, the characteristics of the early recovery period must be taken into account. One-week photos serve primarily to illustrate the early postoperative appearance.

Aiming for a Natural-Looking Nasal Tip

The goal of correcting a drooping nasal tip is not merely to lift the tip itself. It is important that the nasal tip harmonizes with the nasal bridge, the base of the nose, the upper lip, and other anatomical features of the face. In successful surgical planning, a natural appearance, adequate nasal tip support, and the preservation of the functional nasal structure must be considered together. Since every patient's nasal anatomy is different, the technique to be employed and the expected outcome are planned on an individualized basis.

You can read articles related to "droopy nose" prepared by Dr. Murat Enöz and published on this website via this search result link (you can see the articles by clicking on "more posts" at the end of the page) >> https://www.ent-istanbul.com/search?q=droopy+nose

Murat Enoz, MD, Otorhinolaryngology, Head and Neck Surgeon

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