A large or prominent nose may manifest characteristics such as excessive length, width, or notable over-projection. While strategies to reduce the nose's length and width during a rhinoplasty procedure are relatively well established and straightforward, addressing over-projection often presents more intricate challenges.
In essence, over-projection occurs when the nose appears to jut out excessively from the face, creating a pronounced profile. It can be due to excessive septal height , excessive length of the alar cartilages (specifically the medial crura) and or excessive prominence of the anterior nasal spine.
The term "de-projection" refers specifically to the surgical process of minimizing the extent to which the nose protrudes from the face. Undertaking this Rhinoplasty procedure can be notably complex due to several contributing factors.
One of the primary challenges lies in the intricate task of delicately cutting and reshaping the alar cartilages—small cartilages located in the nose's lower region. Specific techniques used to reduce projection by altering the shape of the alar cartilages include vertical alar resection (VAR) or medial crura overlap. In addition to cutting and shaping the alar cartilages part of the upper jaw bone called the anterior nasal spine into which the septal cartilage is attached, may need to be reduced.
The key goal of de-projecting the nose is to do these manoeuvres without dramatically altering the natural appearance of the nasal tip and nostrils. Over-aggressive resection of cartilage or bone, often pursued in an attempt to decrease projection more markedly, can lead to nostril distortion. This can manifest as asymmetrical nostrils or the undesired "notched" nostril effect. Furthermore, an aggressive approach might result in the nasal tip's skin appearing overly lax, given that the underlying cartilage is now considerably reduced. The body may respond to this disparity by producing excess scar tissue beneath the skin, potentially distorting the position and shape of the nasal tip. Owing to these potential complications, the utmost de-projection that's typically considered safe and aesthetically pleasing during rhinoplasty is approximately 3mm. Attempts to exceed this can risk a "botched" appearance.
Efficient post-operative care is paramount to achieving optimal outcomes. To mitigate excessive scar tissue formation following a rhinoplasty aimed at reducing projection, two common practices are implemented. Firstly, medical tape is strategically applied to exert gentle pressure on the nasal skin, minimizing the "dead space" during the healing phase. This method effectively compresses the nasal skin, preventing excessive scar tissue formation. Secondly, steroid injections directly into the nasal tip can be beneficial. These injections not only dissolve any pre-existing scar tissue but also proactively inhibit further scar tissue development.
Sometimes, if the desired de-projection isn't achieved during the initial surgery, a second operation might be necessary. This subsequent operation is usually performed after about 8 months. The interval between the surgeries allows the nasal soft tissues to adapt and contract around the smaller underlying cartilaginous structure, ensuring the nasal tip and/or nostrils aren't distorted. The second operation allows for additional de-projection without the risk of deforming the nasal tip or nostrils.
Deprojection of a nose, while often critically important, stands as one of the more intricate facets of rhinoplasty. Our dedicated team of rhinoplasty surgeons at New You Harley Street are distinguished super-specialists in the domain. Armed with a wealth of expertise, they adeptly address even the most challenging nasal structures, including those that are notably over-projected.
Visit us at 101 Harley Street to discuss your options in addressing over-projection in a large nose.
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