Upturned, Over-Shortened Nose Repair With Revision Rhinoplasty With Caudal Septal Extension Grafting And Open Septoplasty

Thomas Lamperti, MD, narrates an intraoperative video that shows a portion of a revision open septo-rhinoplasty surgery in which he harvests septal cartilage, carves it into a caudal septal extension graft and then derotates the patient's short, upturned nose into a more natural position. He also deprojects her tip so it doesn't stick out as far from the face.

You can learn more about over-rotated tip repair here.

Video Transcript:

"This is Seattle facial plastic surgeon, Dr. Thomas Lamperti. Today I’ll show you how it it possible to refine and slim down a bulbous nasal tip during rhinoplasty using a defatting technique. This tip defatting process involves removing a layer of fibrofatty tissue from the area between the tip cartilages and overlying nasal tip skin. To start you can see that I’ve already exposed the nasal tip using an open rhinoplasty approach. Here I am using scissors to trim some excess soft tissue off of the tip cartilages themselves. I’m careful to to this tissue trimming symmetrically. There is a wide variety of levels of how much of this fibrofatty tissue is available to remove. This surgery is being performed on a patient with an Asian background and she does have relatively thick skin that we’re working on thinning to help produce as refined a rhinoplasty result as possible.

Now I’ll move on  to trimming additional amounts fibrofatty tissue from the skin flap itself. I’m careful to not injure the underlying dermis layer of skin to ensure a good blood supply to the nasal skin. In the end you can see how nasal tip defatting can safely create a   thinner nasal tip soft soft envelope which will ultimately allow for a less bulbous nose. Later on in this surgery I also increased this patient’s tip projection to further add tip definition."