Primary

The main feature in this patient is the overall excess nasal volume, with a tendency toward a drooping tip. This is essentially due to the presence of a marked osteocartilaginous dorsal hump associated with a poorly supported tip. The surgical plan will therefore include correction of the hump and reduction of length, while simultaneously providing adequate tip projection. As in comparable cases, the goal is to reestablish proper proportions between the radix, dorsum, and tip, correcting this nose’s clear tendency to appear elongated, curved, and bottom-heavy. The tip will need to be structurally reinforced with several delicate grafts harvested from the nasal septum, which will provide appropriate shape and long-term stability. In large noses such as this one, where the skin envelope is abundant, it is not possible to make the nose significantly smaller without creating excess skin over the tip (pollybeak deformity). The fundamental objective is instead to achieve the best possible balance between the skin envelope and the underlying osseocartilaginous support structure.

The aesthetic lines of the dorsum have been harmonized.

The mildly bulbous tip has been corrected and triangularized. The transcolumellar incision is barely visible.

In the three-quarter view, the proportions between dorsum and tip are correct. The dorsum transitions into the tip in a harmonious manner.

The profile is essentially straight, with a subtle tip break relative to the dorsum.

In the three-quarter view, the proportions between dorsum and tip are correct. The dorsum transitions into the tip in a harmonious manner.

The profile is essentially straight, with a subtle tip break relative to the dorsum.

With smiling, the tip maintains projection and stability.

In noses with a considerable excess of volume such as this one, the result may continue to change slightly even beyond the first postoperative year, as seen in these photographs taken 2 years after surgery