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- Alar Flare (Wide Nostrils) – when the nostrils (nasal alae) are overly wide or have a very rounded and broad shape, this is often referred to as alar flare. A wide base of the nose can compromise the overall aesthetics of the nose and the entire midface. This issue is often more noticeable when you smile, as this movement results in lateral pull of the nostrils by the face muscles.
- Alar Retraction – sometimes called alar notching, this issue occurs when the rim of the nostril is pulled upward, exposing some of the inside of the nose. This can be related to the orientation of the tip cartilages or a problem that occurs during healing from a nasal surgery or injury.
- Bulbous Tip (Boxy Tip) – some people have an overly broad tip of the nose or an amorphous (less defined) shape in this area. This is related to the shape of the tip cartilages, the thickness of the skin, and other factors. It is often referred to as a bulbous or boxy tip and is a very common issue in patients considering rhinoplasty.
- Crooked or Deviated Nose – a crooked nose is a frequent problem after trauma, though it is also possible to “born that way.” In most cases, the nasal bones (at the top of the nose) deviate to one side. Often, one of the bones is pushed in, while the other is flared out. In some cases, the septum may be deviated as well (see below); this can affect both the internal air passages and the external shape of the nose.
- Deviated Septum – a deviated septum is perhaps the most common deformity in the nose overall. As with a crooked nose, this often occurs from blunt trauma to the nose. In fact, you can injure the septum, resulting in blockage of the airways or external contour abnormalities, without actually breaking the nasal bones. This problem can be treated alone or as part of a more comprehensive functional or cosmetic rhinoplasty.
- Dorsal Hump (Bump) – a bump on the bridge of the nose, also known as a dorsal hump, is the most common cosmetic concern for which patients seek rhinoplasty. This bump makes the entire shape of the nose, especially in the profile, look larger, more masculine, and less refined. The hump is generally made of both bone (nasal bones) and cartilage (the septum and upper lateral cartilages). Each of these tissues must be made smaller and then repaired in order to remove the hump and create a smooth profile.
- Droopy Tip – a droopy tip can be caused by a number of factors, but is most often related to an overly long septum or a downward orientation of the nasal tip cartilages. Each of these areas can be addressed during rhinoplasty, bringing the tip back up to a more aesthetically pleasing position.
- Flat Dorsum – a flat nose, or flat bridge, is a common concern in Asian and ethnic rhinoplasty. This issue is addressed by building up the bridge with soft tissue grafts – generally a combination, including your own cartilage and fascia (connective tissue). Some surgeons use implants, though there are often delayed problems with this technique.
- Hanging Columella – the middle part of the tip of the nose, where the skin separates the two nostrils, is called the columella. A hanging columella occurs when the nasal septum is elongated and/or the tip cartilages are pulled up. This leads to exposure of the inside of the nostril and gives the nose a droopy shape.
- Inverted “V” Deformity – this issue occurs most often after a closed rhinoplasty when the upper lateral cartilage attachments to the nasal bones are loosened. The slight downward shift of these cartilages leads to some exposure of the edges of the nasal bones, giving the appearance of an upside-down capital letter “V.” Repair of this issue requires revision rhinoplasty.
- Nasal Valve Stenosis – tightness of the nasal air passages in the middle third of the nose is a common functional issue that causes patients to seek consultation. Opening up and strengthening this area requires cartilage grafting (such as spreader grafts or batten grafts) and/or suture techniques (flaring stitch). This type of repair may be combined with cosmetic changes to guard against narrowing of the nose caused by making the nose smaller for aesthetic reasons.
- Open Roof Deformity – an open roof or open sky deformity occurs when a dorsal hump (see above) is removed but the nasal bones are not repositioned, leaving a gap in between them. After reduction of the bony bump, the nose bones are carefully repositioned (by performing osteotomies) to make sure that the bridge has a smooth contour.
- Polly Beak Deformity – this deformity occurs when there is excess fullness in the area of the nose just above the nasal tip (supratip), giving a contour that is similar to that of a bird’s beak. Reasons for this problem are many, but most often it is due to residual septal cartilage after a bump is removed. In other cases, this may be prolonged swelling or scar tissue. Repair may require medical or surgical treatment.
- Saddle Nose Deformity – a significant collapse of the bridge of the nose may occur with high-impact trauma, septal hematoma or infection, or intranasal narcotic use. This is a complex issue and may be very difficult to repair, requiring tissue grafts from multiple sites – often rib cartilage.
- Tension Nose – a tension nose occurs when the nasal septum is simply too big for the overlying soft tissue covering. The septal cartilage pushes the tip forward or downward, giving a tight or stretched appearance. Addressing this issue requires removal of a part of the septum and repositioning of the tip cartilages at the columella.
Dr. Evan Ransom is an Ivy League-educated and Ivy League trained Facial Plastic and Reconstructive Surgeon. He is a Double Board Certified Head and Neck Surgeon and Facial Plastic and Reconstructive Surgery and fellowship-trained in facial plastic, reconstructive, and laser surgery. His practice is in the San Francisco Bay Area, serving patients from San Francisco, Oakland, Marin County, Palo Alto, Silicon Valley, Walnut Creek, the East Bay, and all over Northern California.
