Chapter 9 Correction of the Overprojected Nose
Online Contents
Animations
Video ContentIn this Chapter Online at experconsult.com
Correcting an Overprojected Tip on a Long Nose Animation 9.1
Correcting an Overprojected Tip on a Short Nose Animation 9.2
Correcting an Overprojected Tip on a Nose of Optimal Length Animation 9.3
Lowering Tip Projection using the Dome Reduction Technique Animation 9.4
Separating the Domes from the Lining Video 9.1
Placing a Columella Strut Video 9.3
Harvesting a Tip Graft using the Tip Punch Video 9.4
Excising the Redundant Portion of the Lining Video 9.5
Correcting Overprojection by Removal of the Domes Animation 9.5
Pearls
• Ideally, one should see a differential level of 4–6 mm between the glabella and the dorsum, which identifies the depth of the radix.
• An underprojected forehead and glabella can ostensibly make the radix appear shallow. However, in reality, the problem is with the forehead and not the radix or the rest of the nose.
• The forehead should protrude 10–15 mm anteriorly in relation to the globe on the profile view.
• A shallow radix can readily be achieved using a guarded burr with a side-to-side motion.
• The overprojected dorsum will be removed component by component, including the nasal bones, lower lateral cartilages, and septum proportionally.
• Before reducing the caudal dorsal projection, one must take into consideration that removal of the cephalic margin of the lower lateral cartilages, reduction of the nasal spine, lowering the caudal dorsum, and transfixion incision will each reduce the tip projection.
• Some noses that appear to have an overprojected tip may, at the end of the surgery, require additional tip support.
• Careful analysis of the face and nose may indicate that the nose is overprojected and is short, of optimal length, or long.
• If the nose is long and overprojected, one can reduce the tip projection by transecting and overlapping the lateral crura which will accomplish both objectives of shortening the nose and reducing the projection at the same time. The caudal septum has to be removed in a wedge shape proportionally to allow the cephalic rotation of the nose.
• If the nose is short and the tip is overprojected, the medial crura are transected and overlapped to reduce the tip projection while rotating the tip caudally.
• If the nose has a proper length but is overprojected, both the medial crura and the lateral crura are transected and overlapped proportionally and equally.
• A short and overprojected tip can be corrected with an anchor suture that, after passing through the medial crura, will be passed through the posterior portion of the caudal septum.
Overprojected Cephalad Nose
In this fairly common presentation, the radix is too shallow or there is no radix definition and the transition from the forehead to the nose occurs in a linear fashion. As was discussed in Chapter 2, one should ideally see a differential of 4–6 mm between the glabellum and the dorsum on the profile view in a congruous nose. A nose with an overprojected cephalic portion gives the patient the appearance of a reduced intercanthal distance (Figure 9.1), especially if the dorsum and the radix are narrow in addition to being overprojected. One has to differentiate between an overprojected cephalic nose and a receding forehead. In some of the syndromal conditions with mild deformities, whereby the condition cannot be readily recognized, an underprojected forehead and glabellum may produce the ostensible appearance of a shallow radix. Here, one has to assess the distance of the supraorbital rim from the anterior surface of the cornea on straight gaze using the profile view. This measurement should be between 10 and 15 mm. If it is less than 10 mm, then the forehead is underprojected rather than the radix being overprojected.
