your nose is over projected if you fulfill one of the following conditions:
- shitty goode ratio (see first post)
- if the sdlnt (a) makes more than 60% of the whole sagittal length of the nose (see pic below)
- the sdlnt is more 2cm in total
a overprojected nose can be corrected by a rhino (deprojection of the nasal tip) in most cases.
Rhinoplasty For An Over Projected Tip
The goal in rhinoplasty for an overly projected nasal tip is to bring the tip of the nose closer to the face (deprojection of the nasal tip) while maintaining proportion with the remainder of the nose and face. As noted above, the bridge height is often times excessively high in patients with an overly projected nasal tip. Therefore, it is frequently necessary to reduce the bridge height while bringing the nasal tip in closer to the face.
In some rhinoplasty patients, deprojection of the nasal tip simply involves reducing the size of what is commonly referred to as the domal cartilage. The domal cartilage is the highest point of the lower lateral cartilage as it sticks out from the face. If this portion of the lower lateral cartilage is excessively prominent, very careful reduction of the dome can be undertaken to deproject the nasal tip. Some rhinoplasty terms that refer to this type of nasal tip deprojection maneuver include: domal truncation, crural overlay, and vertical dome division. In other rhinoplasty patients, the entire lower lateral cartilage has to detached, moved and reattached to accomplish the desired change in tip projection. Depending on the rhinoplasty surgeon’s expertise and experience, both methods can be done successfully using either an open or closed rhinoplasty approach.
In many cases where the nasal tip is being deprojected, the nose also has to be rotated slightly to maintain proper esthetic balance. To some degree this is directly proportional to the amount of tip deprojection being performed.
some more before/after
Case Study: This 42 year-old female was bothered by her very long nose and wanted it reshaped to be shorter and more proportionate. In addition, her nose was twisted at the tip and deviated to one side. She had trouble breathing through the left side of her nose as well.
Under general anesthesia, an open approach to her rhinoplasty was used. The cartilaginous dorsal height was take down after the upper lateral cartilages were separated. The entire septum was dissected down to the maxilla, detached and a septal graft harvested. The septum was repositioned and bilateral spreader grafts were placed. The domes were separated and reduced by vertical dome division and put back together over a columellar strut graft. The caudal end of the septum was reduced as well. The rhinoplasty was closed with small dissolveable sutures and taped and splinted.
As her before and after pictures show, her nasal tip has been significantly deprojected and brought back much closer to her face. This is a dramatic example of nasal tip deprojection that one does not have to even measure to see that it is so. But by measuring she has had the tip brought back closer to her face by almost 6mms. With this amount of tip deprojection, it was absolutely necessary to lower the cartilaginous bridge height as well. Her result though appears fairly natural even though it is a much smaller nose.
The following is a case example of how the nasal tip can be successfully reshaped to deproject the nose. As was noted above, this particular patient complained of a large nose that she wanted reshaped. We previously discussed how her nasal tip was over projected and bridge height was excessively high. We performed a closed rhinoplasty approach during her cosmetic nose reshaping procedure. This included use of what is referred to as a ‘full transfixion incision’ to drop her nasal tip back closer to the face to deproject the nose. Once this was done, we then reshaped her nasal bridge to bring it down to an appropriate height that matched the new position of her nasal tip.
As you can see in her before and after photos, her nasal tip has been successfully deprojected, or brought in closer to the face. The diagrammed photos demonstrate this more visually when you compare the preoperative nasal tip projection (red line) and bridge height (green line). In the after rhinoplasty photo, you can appreciate how much change has been made to the nose. Keep in mind that cosmetic nose reshaping is a game of millimeters. In this type of rhinoplasty, we have brought the tip in closer to the face by 2-3 millimeters and the nasal bridge by a similar amount, which is all that was needed to result in a beautiful looking nose. The nasal bridge was reduced to create a more feminine looking profile view and the nasal tip was rotated just slightly. Overall, she still looks very natural in terms of her appearance and now has a smaller nose that looks as if she could have been born with it.
maxillary advancement might also decrease the projecting of the nose (not sure yet).