Depressed Nose Correction

 

629. Depressed Nose Correction

Depressed nose correction is not merely about augmenting a low nasal bridge; it typically involves addressing both the sunken nasal tip and the surrounding bony structures of the nose. In many cases, both the nasal bones and cartilage are weak, and the septum is also commonly compromised. If the depression is due to trauma, the surgery becomes more complex, and when the nose has collapsed due to multiple previous rhinoplasties, reconstructive nasal surgery is often required.

Patients with congenitally depressed noses frequently present with maxillary hypoplasia, which is often associated with a mild form of Binder syndrome. In such mild cases, standard rhinoplasty combined with paranasal augmentation can elevate not only the nasal bridge and tip but also the surrounding midface area. If the nasal tip cartilage is weak, it can be reinforced using costal cartilage, making the tip more structurally sound. For more precise augmentation around the nasal base or correction of the nasolabial angle, particulate costal cartilage grafting can be used to fill the micro-deficiencies in the maxillary bone. Artificial implants, on the other hand, carry a higher risk of infection and often fail to fit snugly against the maxillary bone, leading to potential implant migration or inflammation. Thus, autologous particulate cartilage grafting is preferred.

In trauma-induced nasal depression, the status of the nasal septum must be thoroughly evaluated, and septal reconstruction may be necessary. For non-primary surgeries, it is often better to open the columella to allow direct visualization and control over the septum.

In cases where multiple rhinoplasties have resulted in a severely weakened septum and tip cartilage, making nasal support difficult, a cantilever rhinoplasty is recommended. The term "cantilever" comes from architecture, referring to a structure fixed at one end and free at the other. In rhinoplasty, this concept is applied by inserting a single, long, firm cartilage strut, shaped from costal cartilage, from the nasal bridge to the columella to provide support. A double cantilever graft, using two cartilage struts symmetrically placed on either side of the midline, is used when there is little to no septum left, creating balanced support. In some cases, this method is combined with spreader grafts to widen the nasal bridge, forming a hybrid support system. The L-shaped cantilever graft, a structural cartilage piece shaped like an L, is increasingly used to reconstruct short, collapsed, or severely sunken noses.

Septal reconstruction is generally performed with autologous costal cartilage sliced thinly, mimicking the septum’s natural form. When the septum is entirely absent, structural grafts are arranged in an L-shape to simulate a septal framework, similar to building a steel frame in architecture. This is often done in conjunction with cantilever rhinoplasty.

In summary, depressed nose correction involves rebuilding the framework of the nasal bridge and tip using cartilage grafts, while simultaneously reconstructing the central support with septal grafts to restore the collapsed nasal structure.

[Depressed nose correction is a procedure that reconstructs the sunken parts of the nose by augmenting or rebuilding them with cartilage.]

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