Long Nose

LONG NOSE RHINOPLASTY (Washington DC, Virginia & Chevy Chase Maryland)

The primary goal of cosmetic Rhinoplasty is always to bring balance and harmony to the face.  This is accomplished by reducing attention to the nose and redirecting it to the beauty of the eyes and lips.  As such, the nose has to fit the face.  It cannot be too long, too short, too wide or too narrow.  It must be just right.

A long nose is a nose that is simply too long for the face.  This is always relative to the patient’s sex, age, height, facial size and proportions.  For example, occasionally a nose is best left “too long” in order to balance and offset a forehead that is too long, or a chin than is too strong.  Creating an “ideal nose” in such situations would direct undue attention to the less-than-ideal forehead or chin.

A long nose can be too long in the vertical dimension (superior-inferior or cephalic-caudal), &/or it can also be too long in the horizontal dimension (anterior-posterior).  Typically on profile view, the nasal starting point for white (Caucasian) patients is usually at the level of the “superior eyelid crease.” For African American and Hispanic patients, the nasal starting point is usually at the level of the pupils.  The length of the nose in the vertical dimension is essentially equal to 1/3rd of the length of the face or slightly less.  The length of the nose in the horizontal dimension is known as its “projection.”  Projection of the nose should be roughly equal to the length of the upper lip.  We have discussed these proportions in other chapters of this Online Textbook of Rhinoplasty.

{It is important to note that as Rhinoplasty Surgeons, whenever we are reviewing and discussing Facial or Nasal Analysis, we have to use proper photographs.  Proper photographs are taken with an SLR camera (digital or film) using a 105mm lens.  A Single Reflex Lens camera with a 105mm Macro lens creates the least photographic distortion and artifact.  Essentially the photograph is as true to life as possible.  Significant distortions are seen with point-and-shoot cameras, and cell phone cameras, such as the ones often submitted online using the iPhone.  For a Rhinoplasty Surgeon to be able to make proper measurements and analyze the nose, the subject’s face must be in a standardized position.  The Frankfort Horizontal Line (a line drawn from the upper edge of the ear canal to the lower orbital rim) must be parallel to the floor.}

Once the Rhinoplasty Surgeon has made the diagnosis of a “long nose,” the proper surgical techniques must be employed to create a beautiful but natural looking nose.  These Rhinoplasty maneuvers should be used meticulously and incrementally, from least invasive to more aggressive until the desired results have been achieved.

Having a frank discussion between the Plastic Surgeon and the patient is very important.  Similar to how there is only so much a short nose can be safely lengthened, there is only so much a long nose can be safely shortened as well.  Often the rate-limiting factor is the skin and soft tissue envelope.  If the nose is made significantly smaller or shorter, there may be “too much” skin left over.  While most of the time, after a Rhinoplasty, nasal skin “shrink wraps nicely over the newly modified cartilage and bone framework, too much skin will not.  These rare, but important Rhinoplasty cases create situations, where the inability of the skin to drape and shrink-wrap over the nasal framework, leaves a space between the skin and deeper cartilages.  This space is initially occupied with fluid (edema or swelling) after the Rhinoplasty.  But over a matter of weeks and months, this edema fluid is replaced with scar tissue.  This problem is most often seen in Rhinoplasty patients with very thick and stiff skin.  Thick skin is much less likely to simply drape and shrink-wrap over the deeper cartilages and bones of the nose.  In many situations, serial monthly conservative steroid injections may be necessary to “melt” this scar tissue and allow the skin to settle over and adhere to the nasal framework.  However, in cases where the nasal cartilages and bones where made significantly smaller (too small), the skin may be unable to adhere properly, creating less than desired results.  Experienced Rhinoplasty Surgeons must not make such mistakes. More importantly, Rhinoplasty Surgeons must educate their patients during the Cosmetic Rhinoplasty consultation, using computer imaging, about such pitfalls and limitations.  This way, each Rhinoplasty patient will be able to visualize the limits of Rhinoplasty prior to surgery.  In certain cases the nose simply cannot be made that much smaller or shorter, just like in other cases, it cannot be built up greater than a certain length or size.  There are limits and being realistic is crucial in achieving excellent Rhinoplasty results and having happy Rhinoplasty patients.  In all cases, an experienced Plastic Surgeon should be able to significantly improve the nose and deliver very nice Rhinoplasty results.