Correcting a short or upturned nose

Features of a short or upturned nose

A short nose is one whose length from the root of the nose to the tip looks short relative to the face. One review explained that although the causes vary greatly, short noses share common features: the nose is short, the tip is rotated too far upward (overrotation), and the nostrils show a lot ^[1].

What is commonly called an upturned nose often refers to cases where the upward rotation of the tip and nostril show are especially noticeable. The same review focused on identifying the exact cause of a short nose and the anatomy involved ^[1]. This is because the method of correction depends on the cause.

What causes a nose to become short

One example of a congenital cause is Binder syndrome. It is a rare developmental abnormality that affects the front of the upper jaw and the structure of the nose, and it is described as possibly causing a flat, underdeveloped midface, an abnormally short nose, a flat bridge, an underdeveloped upper jaw, and a relatively prominent lower jaw or an underbite ^[4]. Because the problem is not limited to the nose, an approach in which several medical specialties plan treatment together has been proposed ^[4].

An acquired cause can be previous nose surgery. In rhinoplasty for Asian patients, as septal extension grafts and synthetic bridge implants came into wide use, surgery-related (iatrogenic) complications such as a shortened nose and damage to the remaining septum have been pointed out ^[2]. A review of revision surgery in Asian patients also described a short nose deformity after silicone rhinoplasty as a common yet challenging problem ^[3].

How is a short nose corrected?

Correcting a short nose focuses on moving the tip downward and forward and building a support structure to hold it in that position. A septal extension graft is described as a method that can adjust the projection, shape, and rotation of the nasal tip ^[2].

A review of rhinoplasty in Asian patients presented a graft that extends the L-shaped support structure of the septum, describing it as able to reinforce the lower two-thirds of the nose forward and downward in Asian patients with relatively small noses ^[2]. The indications described for this method include revision surgery for noses that have become shorter because of synthetic implants ^[2].

Lengthening the nose requires the skin and soft tissue covering it to stretch along with it, so how much give these tissues have can also affect how far the nose can be lengthened. That is why, even among similarly short noses, the range of possible change differs from person to person.

Why your own cartilage matters in revision surgery

According to a review of revision surgery in Asian patients, septal cartilage in Asian patients is generally weak and small, so it is easily damaged during the first surgery and prone to secondary deformities ^[3]. For this reason, revision surgery is described as more often requiring major reconstruction of the septal cartilage framework ^[3].

The same review summarized that the patient's own tissue, such as ear cartilage (conchal cartilage) and rib cartilage (costal cartilage), plays a central role as material for a new bridge graft or for rebuilding the septum ^[3]. It especially stressed the need to be skilled at handling rib cartilage properly ^[3].

Complications and precautions

Common problems with synthetic bridge implants that lead to revision surgery include shifting of the implant, malposition, extrusion, recurring inflammation, and infection ^[3]. A nose that remains crooked or becomes crooked again, undercorrection of a convex bridge, and complications related to tip grafts are also summarized as problems that frequently require revision surgery ^[3].

It has also been pointed out that the wide use of septal extension grafts and synthetic bridge implants has actually led to surgery-related (iatrogenic) complications such as a short nose and damage to the septum ^[2]. This is why the amount and condition of the remaining cartilage need to be checked carefully when deciding on a correction method. There are also general surgical risks such as bleeding, infection, and asymmetry, and recovery and results vary from person to person.

What to check during your consultation

A short nose can have many causes, so even noses that look similar may need different approaches ^[1]. It is hard to judge the condition of the cartilage and skin from photos alone, so it is best to decide based on an in-person examination.

• Whether the short appearance is congenital or the result of previous surgery
• Records of any previous surgery and the type of implant used
• How much septal cartilage remains, and its condition
• The likelihood of needing ear or rib cartilage, and how that site would heal
• Whether upper jaw development is involved and care from another specialty is needed