Nose lengthening with rhinoplasty: when and how is it done

Rhinoplasty – This is a concept that combines all surgical interventions to correct the shape of the nose. Nose lengthening in itself is not a frequent reason for patients to consult plastic surgeons, but it can be one of the components of complex operations to correct the shape of the nose. A short nose is a deformity of the development of the nose, with the tip of the nose often raised upward, which increases the nasolabial angle and exposes the nostrils. Such a picture affects the aesthetic appearance of the face, making it less attractive. Rhinoplasty for nose lengthening helps to eliminate this defect and make a person's face much more aesthetically interesting and beautiful.

Nose lengthening technique depends on the original shape of the nose

The choice of rhinoplasty technique for nose lengthening depends on the initial shape of the patient's nose.

• With a short nose and an upturned tip of the nose, the separation of the upper and lower lateral cartilages, the lengthening of the lateral crura with downward rotation of the tip of the nose and the shortening of the posterior sections of the caudal part of the nasal septum are performed.  It is in this position that all structures of the nose are stabilized.
• If a patient has a humpbacked nose with a deep root, rhinoplasty with elevation of the root of the nose with grafts overlay without manipulation in the area of ​​the tip of the nose and nasal septum allows to achieve the maximum optical effect of lengthening the nose.
• For a round nose, there is a need for a slight lengthening of the nose, which can only be achieved with rhinoplasty by resection of the cephalic portion of the lateral crus.

True nose lengthening technique

True elongation of the nose implies not only minimal optical correction of its shape during rhinoplasty, but a more extensive surgical intervention.  During  rhinoplasty, the skin is mobilized from the outside of the exposed cartilaginous elements and the mucoperichondria from the inner surface.

Due to the reduction of the support of the medial legs after resection of the area of ​​the quadrangular cartilage at the level of the septal angle, the nose is lengthened. The effect of lengthening the nose can also be achieved by downward rotation of the tip of the nose by sutures that pull the medial crura to the quadrangular cartilage at a level ventral to the median septal angle.

Use of spacers for nose lengthening surgery

Installation of struts is not an effective way to lengthen the nose, as the struts between the medial crura can be resorbed and displaced, thus preventing upward rotation of the tip of the nose. For a more pronounced elongation of the nose, a special Byrd spacer is used, which is extended distally from the anterior septal angle into the interdome space, where the medial crura are sutured to it, and thus the nasal septum is advanced. Due to this, a more pronounced lengthening of the nose after rhinoplasty is achieved.

Maximum nose lengthening due to massive graft

For maximum nasal elongation in rhinoplasty, a more massive elongating septum graft must be used. In 2000, Hubbard proposed the use of a more rigid attachment of the septum lengthening graft, fixing it as a dorsum widening graft. One of the most popular techniques for this graft use is the tongue-in-groove technique, in which a nasal septal extension graft is fixed between two elongated dorsum expansion grafts. This rhinoplasty technique allows you to maximize even the shortest nose and make it much more refined and attractive.