An Algorithm for Treatment of the Drooping Nose

Abstract

Nasal tip ptosis ("drooping" or long nose) occurs when the tip of the nose is more caudal than what is deemed ideal. Intrinsic factors, such as elongated or caudally-rotated lower lateral cartilages, can lead to nasal tip ptosis. Extrinsic factors, such as elongated upper lateral cartilages or excessive caudal anterior septum and heavy nasal skin, can push the nasal tip caudally and lead to drooping of the nasal tip. The loss of maxillary or nasal spine support may enhance the potential for tip ptosis. In addition, a hyperactive depressor nasi septi could, as a result of continuous pull on the tip, result in tip ptosis. Aging or previous nasal procedures (such as the Goldman-type tip surgery) where the continuity of the lateral and medial crura of the lower lateral cartilages have been violated may cause a weakening of the tip-supporting mechanisms and de-rotation of the nasal tip. Correction of this deformity is challenging and rewarding; it can resolve both the cosmetic deformity and nasal obstruction symptoms related to this entity. The goal of this article is to present our current principles of diagnosis and treatment of nasal tip ptosis, as well as to introduce and algorithm of preferred methods and techniques for its reliable and stable correction. Correction of the nasal tip ptosis requires accurate diagnosis, a recognition of the interplay between various anatomic components, specific strategy planning, and a correction of anatomic abnormalities.