Septal Extension (Septal Cartilage) + Alar Reduction + Nasal Tip Refinement + Nasal Bone Osteotomy & Narrowing

Treatment details: Septal Extension (Septal Cartilage) + Alar Reduction + Nasal Tip Refinement + Nasal Bone Osteotomy & Narrowing

A nose is rarely improved by correcting one element in isolation. Narrowing the bones without supporting the tip leaves the tip looking heavier against a slimmer bridge, and lengthening the tip without narrowing the base widens the appearance from the front. Septal cartilage was chosen as the graft material because it is straight, rigid enough to hold projection, and taken from within the same operative field, so no separate donor site is needed. The alar base was reduced on both sides after the tip position was set, since the width that needs removing changes once the tip is projected. One month is early for a nose built this way. What is visible here is the settled bone position, not the final definition of the tip.

Cutting and repositioning the nasal bones produces bruising around the eyes that is at its worst in the first three to five days, and a plaster or splint is worn for about a week. A step or asymmetry along the dorsum can appear as the swelling resolves and is the commonest reason for revision. Harvesting septal cartilage carries a small risk of septal perforation and can affect airflow, and narrowing the bony vault can reduce the internal valve. Numbness of the tip is usual for several months while sensation returns. Scars at the alar base stay pink for months before fading. Bleeding, infection around the graft, and prolonged tip swelling are all recognised. Contact sports and glasses resting on the bridge are avoided for six weeks.