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Medicine » Surgery » "Miniinvasive Techniques in Rhinoplasty", book edited by Nikolay Serdev, ISBN 978-953-51-2260-9, Published: March 9, 2016 under CC BY 3.0 license. © The Author(s).

Chapter 2

Excision of Prominent Posterior Septal Angle and Nasal Spine for Downward Tip Rotation, in Short Upper Lip, or Over-Rotated Tip

By Nikolay P. Serdev
DOI: 10.5772/62062

Article top

Overview

A: Long aquiline nose, Short upper lip, elongated septal cartilage, and nasal pyramid. Author’s T-excision, or cephalic strip excision and caudal septal shortening could help in this case, together with posterior septal angle and nasal spine resection (marked) to elongate the upper lip. B. Ethnic (Asian or Afro-American) or iatrogenic obtuse nasolabial angle with over-rotated tip. Precise excision of the posterior septal angle and nasal spine (marked) can help to correct the nasolabial and tip angle.
Figure 1. A: Long aquiline nose, Short upper lip, elongated septal cartilage, and nasal pyramid. Author’s T-excision, or cephalic strip excision and caudal septal shortening could help in this case, together with posterior septal angle and nasal spine resection (marked) to elongate the upper lip. B. Ethnic (Asian or Afro-American) or iatrogenic obtuse nasolabial angle with over-rotated tip. Precise excision of the posterior septal angle and nasal spine (marked) can help to correct the nasolabial and tip angle.
A: Prominent posterior septal angle and nasal spine. B. 2-3 mm excision of the posterior septal angle incl. nasal spine. C. Correct position of the posterior septal angle.
Figure 2. A: Prominent posterior septal angle and nasal spine. B. 2-3 mm excision of the posterior septal angle incl. nasal spine. C. Correct position of the posterior septal angle.
A. Before. Long nose and proportionally shortened upper lip. B. Immediately after T-excision for tip rotation to obtain correct aesthetic proportions of the face, combined with a 2 mm excision of the prominent posterior septal angle and nasal spine (for elongation of the upper lip and achieving a correct proportion of the lower face). Simultaneous brow lift and lip augmentation. The picture is taken in the operation room. The face is still not cleaned from the Braunol disinfection.
Figure 3. A. Before. Long nose and proportionally shortened upper lip. B. Immediately after T-excision for tip rotation to obtain correct aesthetic proportions of the face, combined with a 2 mm excision of the prominent posterior septal angle and nasal spine (for elongation of the upper lip and achieving a correct proportion of the lower face). Simultaneous brow lift and lip augmentation. The picture is taken in the operation room. The face is still not cleaned from the Braunol disinfection.
A. Before. Ethnic long and aquiline nose, disrupting the correct facial proportions. Short upper lip, with incorrect 3:1 proportion of the lower face. B. After. Rhinoplasty, including humpectomy, digital fracture vs. lateral osteotomy, T-excision for tip rotation and 3 mm excision of the prominent posterior septal angle and nasal spine. The result is correct aesthetic proportions of the face and lower third of the face. The photo is taken in the operation theater, immediately after ambulatory closed rhinoplasty – atraumatic, mini-invasive, bloodless. The result is beautification.
Figure 4. A. Before. Ethnic long and aquiline nose, disrupting the correct facial proportions. Short upper lip, with incorrect 3:1 proportion of the lower face. B. After. Rhinoplasty, including humpectomy, digital fracture vs. lateral osteotomy, T-excision for tip rotation and 3 mm excision of the prominent posterior septal angle and nasal spine. The result is correct aesthetic proportions of the face and lower third of the face. The photo is taken in the operation theater, immediately after ambulatory closed rhinoplasty – atraumatic, mini-invasive, bloodless. The result is beautification.
A. Before. Ethnic long and aquiline nose disrupting the correct facial proportions. No self-confidence, uncertain appearance. Short upper lip. B. After. Rhinoplasty, including humpectomy, digital fracture vs. lateral osteotomy, T-excision for tip rotation and 3 mm excision of the prominent posterior septal angle and nasal spine to improve the lower third of the face. The result is beautification and improved self-confidence.
Figure 5. A. Before. Ethnic long and aquiline nose disrupting the correct facial proportions. No self-confidence, uncertain appearance. Short upper lip. B. After. Rhinoplasty, including humpectomy, digital fracture vs. lateral osteotomy, T-excision for tip rotation and 3 mm excision of the prominent posterior septal angle and nasal spine to improve the lower third of the face. The result is beautification and improved self-confidence.

Excision of Prominent Posterior Septal Angle and Nasal Spine for Downward Tip Rotation, in Short Upper Lip, or Over-Rotated Tip

Nikolay P. Serdev1

1. Introduction

If the upper lip is shortened by a too long septum, or if shortening of the longer nasal pyramid is necessary, the prominent posterior septal angle can be excised, together with the anterior nasal spine [4]. This maneuver deepens the nasolabial angle and can be used also in cases of over-rotated tip (obtuse tip).

2. Anatomy

The length of the nasal pyramid should occupy the middle-third of the face. Longer pyramid should be shortened, if unproportional to the face. This could happen when reducing the prominent posterior septal angle and the prominence of the anterior nasal spine.

In long and aquiline noses the facial proportions are imbalanced. Often, except the elongation of the caudal septum, the nasal pyramid (including the posterior septal angle) and nasal spine can also be elongated with shortening of the upper lip. In these cases cephalic strip excision alone does not suffice to shorten the elongated nasal pyramid.

Vice versa, in Asian and Afro-American noses, as well as in some secondary iatrogenic cases, the tip can be over-rotated with an obtuse nasolabial angle, which could be a good indication for excision of the prominent posterior septal angle and anterior nasal spine.

media/fig1.png

Figure 1.

A: Long aquiline nose, Short upper lip, elongated septal cartilage, and nasal pyramid. Author’s T-excision, or cephalic strip excision and caudal septal shortening could help in this case, together with posterior septal angle and nasal spine resection (marked) to elongate the upper lip. B. Ethnic (Asian or Afro-American) or iatrogenic obtuse nasolabial angle with over-rotated tip. Precise excision of the posterior septal angle and nasal spine (marked) can help to correct the nasolabial and tip angle.

media/fig2.png

Figure 2.

A: Prominent posterior septal angle and nasal spine. B. 2-3 mm excision of the posterior septal angle incl. nasal spine. C. Correct position of the posterior septal angle.

3. Indications

Ethnic aquiline long noses with elongated nasal pyramid as well as ethnic (Asian or Afro-American) or iatrogenic over-rotated tip with obtuse nasolabial angle.

4. Surgical technique

It is an outpatient technique under local anesthesia. It could be performed as an independent procedure in cases of iatrogenic or ethnic over-rotated tips as well as in case of long or aquiline noses.

In all cases, a retrocolumellar incision is performed, which will be prolonged downward to excise about 2 mm, rarely 3 mm, of the posterior septal angle together with the anterior nasal spine.

The author fixes the columella to the septum with transmucosal mattress sutures, which remain for 2–3 weeks. No bandages or tampons are necessary for this separate procedure. It is mini-invasive, atraumatic, and bloodless.

5. Clinical cases

media/fig3.png

Figure 3.

A. Before. Long nose and proportionally shortened upper lip. B. Immediately after T-excision for tip rotation to obtain correct aesthetic proportions of the face, combined with a 2 mm excision of the prominent posterior septal angle and nasal spine (for elongation of the upper lip and achieving a correct proportion of the lower face). Simultaneous brow lift and lip augmentation. The picture is taken in the operation room. The face is still not cleaned from the Braunol disinfection.

media/fig4.png

Figure 4.

A. Before. Ethnic long and aquiline nose, disrupting the correct facial proportions. Short upper lip, with incorrect 3:1 proportion of the lower face. B. After. Rhinoplasty, including humpectomy, digital fracture vs. lateral osteotomy, T-excision for tip rotation and 3 mm excision of the prominent posterior septal angle and nasal spine. The result is correct aesthetic proportions of the face and lower third of the face. The photo is taken in the operation theater, immediately after ambulatory closed rhinoplasty – atraumatic, mini-invasive, bloodless. The result is beautification.

media/fig5.png

Figure 5.

A. Before. Ethnic long and aquiline nose disrupting the correct facial proportions. No self-confidence, uncertain appearance. Short upper lip. B. After. Rhinoplasty, including humpectomy, digital fracture vs. lateral osteotomy, T-excision for tip rotation and 3 mm excision of the prominent posterior septal angle and nasal spine to improve the lower third of the face. The result is beautification and improved self-confidence.

6. Conclusion

Excision of caudal septum in long noses, combined with excision of prominent posterior septal angle and nasal spine, is a very effective technique. It is of great help in cases of longer caudal septum and nasal pyramid with a short upper lip, as well as in cases of over-rotated noses. The procedure helps to adapt the face to correct aesthetic proportions, which is the main goal in beautification. The technique itself is time-saving, atraumatic, and also very well tolerated by patients, with no downtime and immediate return to work and social life.

References

1 - Serdev NP. Sliding of the columella by the Serdev Technique, Live Surgery Workshop, The International Academy of Aesthetic Surgery and Aesthetic Medicine, Krulig Clinic, Caracas, Venezuela, Nov. 1999
2 - Serdev NP. Principles of Face Beautification, Third World Congress of the International Society of Aesthetic Surgery, Tokyo, April 8-10, 2000
3 - Serdev NP. Rhinoplasty for Beautification. Asia Pacific Craniofacial Association. Third Conference, Shanghai, P.R. China, Oct. 30–Nov. 1, 2000
4 - Serdev NP. Beautification rhinoplasty. Int J Cosm Surg 2006; 6(1): 1-53
5 - Serdev NP. Serdev techniques in beautification rhinoplasty: T-zone excision, columella sliding, Serdev sutures. Int J Cosm Surg 2008; 8(1):388-469
6 - Serdev NP. Nasal tip refinement, rotation, projection, alar base narrowing In: Serdev NP, Ed. Serdev Sutures® Face and Body Lifts and/or Volumising. Marllor editions, Italy, 2013: 75-81
7 - Serdev NP. Serdev Sutures® in middle face 4. Beautification rhinoplasty – tip rotation and refinement, alar base narrowing. In: Serdev NP, Ed. Miniinvasive Face and Body Lifts – Closed Suture Lifts or Barded Thread Lifts. Intech, Rijeka, 2013. Available from http://www.intechopen.com/books/miniinvasive-face-and-body-lifts-closed-suture-lifts-or-barbed-thread-lifts/serdev-sutures-in-middle-face.
8 - Serdev NP. Course: Beautification rhinoplasty, t-zone excision, columella sliding, suture methods, Updates in IV sedation and analgesia. 2005; Feb. 23. Available from: http://ijcs.org/courses/2005/90/index.php