Four common nose shape anomalies that increase the odds of unfavorable results from rhinoplasty

Rhinoplasties (nose jobs) are among the most difficult cosmetic surgical procedures and unfavorable results are not unusual, making a number of patients seek additional rhinoplasties to correct the deficits of the first one.  People considering a nose job and cosmetic surgeons in particular should be aware of four types of nose deformities that predispose to unfavorable results.^{(1, pdf)}

Low radix/low dorsum

The dorsum is the front surface of the nose.  One has a low radix if the upper part of the nose is insufficiently projecting.  In the example shown below, adding an implant/graft onto the woman’s upper nasal part has the effect of making the lower part of the nose look less prominent even though it is slightly more prominent because there is a nose tip graft, too.  Straightening the nose by reducing the lower part of the nose would have been unadvisable.

Fig. 1. A woman with a low radix/insufficiently projecting upper nasal region (left) and after surgical placement of grafts from the upper region to the tip.

Narrow middle vault

Any upper cartilaginous vault that is at least 25% narrower than the upper or lower nasal thirds.  An example is shown below.  In her, the dorsal region was cut and long grafts implanted; air flow improved 2.5 times.

Fig. 2. A woman with a narrow mid-vault (left) and after surgical correction including the placement of grafts.

Inadequate nose tip projection

This problem arises if a nose tip does not project to the level of the anterior septal angle (anterior is front, septum is the portion where the left and right halves of the nose join).  An example is shown below.

Fig. 3. A woman with a nose tip that does not project enough (left) and after surgical correction by the placement of a tip graft as well as a graft in the upper nasal region.

Cephalic malposition of the alar cartilage lateral crura

This problem arises if the lateral crura are rotated 45 degrees or more to the plane of the alar rims.

A diagram of the lower portion of the nose explains the anatomical terms.

Fig. 4. The anatomy of the lower nose. The alars are marked by al; al’ marks the alar rims. 

The following image shows an example of the problem and its correction.

Fig. 5. A woman with alar malformation (left) and after its surgical correction; a graft was also placed to increase the projection of the upper nose. 

A number of individuals have more than one of these shape problems and had best choose their surgeon wisely since multiple areas of the nose would need to be worked on to achieve a good result.

References

1. Constantian, M. B., Four common anatomic variants that predispose to unfavorable rhinoplasty results: a study based on 150 consecutive secondary rhinoplasties, Plast Reconstr Surg, 105, 316 (2000).