This is a great example of a young lady who desired rhinoplasty in order to create a more symmetrical Nasal tip region. She presented to our office here in San Diego noting a crooked, or displaced, nasal tip – with deviation of the tip of her Nose off to her right side as can be seen here.

One way to assess crookedness of a nose is to draw a vertical line from the glabella (the area in between the eyebrows) down to the middle of the upper lip. There should be fairly symmetrical amounts of the nose on each side as it courses down to the nasal tip region. In this particular case, her nose was significantly displaced off to her right side. In fact, a majority of her nose is pushed off to the side.

Interestingly, her crooked nasal deformity was largely due to the cartilage of the nose – and not the bony part of the nose. In so many crooked nose cases, the deformity arises from a displaced bone – such as you would see from an accident. This young lady also had trauma to her nose. But in this instance, it was the lower two-thirds of the nose that was displaced as a result of the injury,

Functional Nose Problem

In addition to her nose being pushed off the midline, she had problems with the functionality of her nose. Her septum was deviated and she had what is called nasal valve stenosis – a fancy term meaning specific areas of her cartilage were weakened and collapsed. This meant that much of her nose reconstruction would be covered by health insurance since there was a problem with her breathing that was documented and established.

One of the main problems with her nose was involved the Caudal Septum. This is the portion of the nasal septum that extends down to junction with the upper lip. The caudal septum is the first 1-2 centimeters of the nasal septum that sits in between the two nostril openings.

In her case, if you look from underneath the nose, you will see just how asymmetrical her nostrils are prior to rhinoplasty surgery. Normally, a true base view of the nose is taken from even further below the nose with the head tilted back. But for demonstration purposes, this angle is shown here. Just look at how different the two nostril openings are – which is a direct result of how displaced her caudal septum was in this photo. Instead of being positioned more in the middle of her face, the caudal septum was tilted off to her right side as indicated by the arrow in the adjacent photo.

You can also see how her philtrum is a bit distorted from the nasal deviation. The philtrum is the white upper lip that has two vertical ridges with a slightly concave area in between them. Since the philtrum adjoins to the bottom of the nose, this type of nasal deviation can also contribute to the upper lip appearing asymmetrical – as is the case here.

Tip Rhinoplasty Surgery

Dr. Hilinski ended up performing an open reconstructive rhinoplasty on this patient to help her breathe better while also improving the shape and position of the nasal tip. The latter was actually required in order for the functional part of the nose to be improved. The surgery included the following maneuvers:

• Open rhinoplasty approach
• Complete septoplasty
• Relocation of the caudal septum
• Spreader grafting to splint the nasal alignment
• Tip cartilage grafting

Tip Rhinoplasty Photos

Here are some before and after photos of this patient’s case – showing what is a very beautiful improvement in the shape of her nose. Pay close attention to how Dr. Hilinski was able to make her nasal tip much more symmetrical – while repositioning it more in the middle of her face.

Tip Rhinoplasty Transformation

Here is a nice, short video of how this patient’s nose was transformed as a result of Dr. Hilinski’s reconstructive septorhinoplasty.