In some cases of rhinoplasty, you will come across a situation where the bottom part of the nose – primarily the columella – will contribute to displacement and disfigurement of the upper lip. That is precisely the situation in this case example presented here. This female rhinoplasty patient from San Diego desired to have her nose reshaped in order to make her nasal tip more symmetrical – and less distracting. In addition, she had trouble breathing through her nose, which was not surprising given how much her nasal tip and septum were deviated.
When Dr. Hilinski first examined her nose, one of the first things noted was just how far her columella was displaced. It was so displaced that her philtrum was being pulled off to her left side. This is highlighted in the adjacent photo diagram where the philtrum is outlined in red. The philtrum is the shallow depression that runs vertically along the upper lip in between the nose and the pink lining of the lip. Normally, the philtrum is relatively in the middle of the face. In this case, you can see how it has been displaced, or pulled, over to her left – which is a direct result of the nasal columella being so crooked. It is not often that you see this type of nose issue that can have such an impact on the upper lip as well.
Most of what you see in this 2 x 2 centimeter area is directly attributed to the nasal septum being overly developed. The distal end of the septum (called the caudal septum) was so overgrown, it jutted down and to the side. The two medial crura that are normally sitting adjacent to the end of the septum were displaced in a similar manner.
Dr. Hilinski ended up recommending an open septorhinoplasty approach to address her anatomical issues. He opened the nose by making an incision across the columella in between the two nostril openings. Ultimately, her nose required him to reposition and reshape the end of the nasal septum. This was NOT a finesse-type rhinoplasty surgery. Her nose required extensive and drastic changes to the shape of her nose to attain the desired goal. In the process of doing this, the septum had to be brought back into a more midline orientation. Only after this was accomplished was Dr. Hilinski able to rebuild her entire nasal tip. The medial crura had to be reset onto the septum and sewn into a new position. Then, the actual cartilage that comprises the nasal tip had to be reorientated and reshaped. In doing so, the nasal tip was made more symmetrical and the nostril openings were secured so she could breathe much better.
Rhinoplasty Upper Lip Reshaping
The dramatic end result of this very complex type of reconstructive septorhinoplasty is shown here. The patient is now about 3 years out from her rhinoplasty with Dr. Hilinski and has a markedly improved nasal airway. But look at the changes that have occurred with her upper lip. The philtrum is now positioned in a much more midline orientation and looks quite normal. And this was a passive change that happened only because of the alterations made to the caudal septum and columella. In addition, her nose now looks much more normal – yet natural and fitting for her face.