See how Dr. Lamperti is able to use rib cartilage to carve a caudal septal extension graft to lengthen and counter-rotate a short, upturned nose during revision rhinoplasty.

One of the most complicated maneuvers in rhinoplasty surgery is the treatment of a nose that is too upturned or over-rotated. The effect of this tip positioning too far up is that of an overly short nose in which people end up looking up the nostrils too easily on front view.

I've gone into a in depth discussion of the various ways to fix an upturned nose here. To delve into this treatment further I've just uploaded an intra-operative video that shows one of the techniques that can be used to counter-rotate an upturned tip: the caudal septal extension graft. 

You can see in the schematic drawing above how the graft is placed at the end of the septum to effectively lengthen it.

This video shows how I was able to carve the graft from a portion of rib cartilage. It then goes onto show how to attach the graft to the septum itself. Lastly, it shows how the tip cartilages can be brought downward onto the newly lengthened septum to fix them in their new position.

Check out the upturned nose repair video itself in my rhinoplasty video section here