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De-Rotation of the Nasal Tip

As a surgeon who does many nasal revisions, I am often asked to correct an overly rotated nose: the so-called “pig’s nose or snout”. It generally results from an over-resection of cartilage at the end of the nasal septum (wall separating the two nasal chambers), but can result from other inappropriate maneuvers, as well.

Depending on the degree of over-rotation, as well as the amount of associated nostril retraction, there are several methods of correcting this. Since the nasal tip and adjacent nostrils are intimately connected, we can use a cartilage graft placed at the end of the septum to push the entire lower third of the nose down. This “septal extension graft” essentially replaces what was removed in an earlier surgery. Also, because the graft has to be lined with mucous membrane, a moderate amount of freeing up of the internal lining has to be performed to allow for this advancement.

The accompanying “before & after” photos show one such example using a septal extension graft to de-rotate a nose.

Finally, other lesser procedures can be employed for less severe cases. A cartilage tip graft can be placed below the nasal tip, to give the illusion of de-rotation . And a composite graft composed of cartilage and skin can be placed within the nostril to selectively de-rotate that.

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