Pinched Nose Tip Revision
A pinched nasal tip is synonymous with complications Nasal Valve Collapse or Tip Bossae.
A pinched nasal tip is a result of three different causes, the most common being previous Rhinoplasty Surgery. In the 1980s, Reduction Rhinoplasty was widely practiced and it was “fashionable” to remove excessive amounts of cartilage in the nose with the desired result being a small, scooped, upturned nose. The cartilages that are aggressively removed during these reduction procedures are critical to proper nasal function (breathing), the aesthetic appearance of the nose and to the overall structure and support of the nose and tip.
These specific cartilages are the lower lateral cartilage wings that keep the nostril open giving one the ability to breathe or pass air in and out easily. Surgical maneuvers that include removing strips of cartilage, (also known as cephalic strips) and cutting into the domes of the lower lateral cartilage, (known as dome division) produce short term narrowing of the nasal tip with slight rotation and projection. Over time, the removal of these cartilages as well as splitting cartilage in the dome area unfortunately result in tissue contraction between the upper and lower cartilages as well as in the nasal tip area. This contraction essentially collapses the soft tissue of the nostril. In thin-skinned patients, the lower lateral cartilages show through the skin as an asymmetric pattern known as Tip Bossae. The upper portion of the nasal tip (known as the internal nasal valve) collapses due to lack of cartilage support. This is Nasal Valve Collapse. Tissue contraction that results from lack of cartilage support can lead to severe nasal obstruction appearing to the naked eye as a “pinched tip”.
Patients seek Revision Rhinoplasty of a pinched tip for several reasons with the most common being that they are experiencing difficulty breathing as a result of Nasal Valve Collapse. This is not only a functional issue. Nasal Valve Collapse is not aesthetically pleasing either. Patients can exhibit varying degrees of collapse and not even know it. Overzealous reduction of nasal cartilage is still practiced today in Rhinoplasty Surgery.
Other causes of the Pinched Nose Tip include trauma or injury. In rare cases, though they can occur, some may be born with these issues.
Revising a pinched nasal tip is performed by adding back cartilage to the upper and lower lateral cartilages while reconstructing the nasal tip with either a strut graft or cartilage shield graft. These grafts are most commonly harvested from the septum and/or ear. Both areas can provide adequate cartilage for the reconstruction of the pinched tip.
This procedure can be performed by skilled surgeons through a Closed Rhinoplasty approach; however, it is advocated that an Open Rhinoplasty approach be used in order to directly visualize all the lower lateral cartilaginous structures and address the tip structures with adequate cartilage grafting.
After the functional portion of the surgery is performed and the patient’s nasal valves have been correctly opened back up, the aesthetic portion is restored. Other common complications with a pinched tip can include Saddle Nose Deformity and Pollybeak Deformity.