Rhinoplasty on aquiline nose with S-shaped dorsum and low radix: before and after one year
Case fact sheet
- Patient: Female, 27 years old
- Reason: aesthetic
- Starting nose: Very pronounced S-shaped dorsum, with an extremely low radix; bulbous and drooping tip; nose slightly deviated to the left
- Technique: Structural rhinoplasty with ultrasonic instrumentation: radix grafted with cartilage powder and fibrin-rich plasma, spacer grafts (spreader grafts) on the back and septal extension graft at the tip
- Septum and turbinates: Septoplasty and turbinate reduction in the same surgery, as part of structural rhinoplasty
- Approach: Draw the new back from very low down without lowering the radix further, and remove the bulbous and droopy appearance from the tip.
- Result: one year after the operation
- Entry: 1 night
- Anesthesia: general type TIVA
- Duration: 3 hours long.
A very pronounced S-shaped dorsum, with an extremely low radix, a bulbous and drooping tip, and the nose slightly deviated to the left. Structural rhinoplasty with ultrasonic instrumentation: the radix, slightly raised with cartilage grafting; the dorsum, reconstructed with spacer grafts; and the tip, mounted on a septal extension graft.
Photos one year after the operation
Twelve-month check-up. There were two things here that can only be assessed over time: the grafted radix, which needs to integrate, and the tip, which in the first few weeks remains swollen and appears thicker than it will ultimately be. At six weeks, this nose still hadn't shown its final result; at one year, it did. Same views, same lighting, and same framing before and after.
Comment by Dr. Gustavo Sordo
Reason for consultation
Aesthetic: she wanted to improve the profile of her nose.
What I observed when evaluating it
A very pronounced S-shaped dorsum, with the radix—the point where the nose begins, between the eyes—extremely low. The tip was bulbous and droopy, and the nose was subtly deviated to the left.
What was important to preserve
The height of the radix. With such a low radix, the new back line must be drawn from very low down, and what cannot be done is to lower it even further.
My surgical approach
Raise the radix slightly with a cartilage powder graft and fibrin-rich plasma, perform a structural rhinoplasty of the dorsum with spacer grafts, and mount the tip on a septal extension graft to remove the bulbous and droopy appearance.
Why I chose this technique
This type of nose responds very well to structural ultrasonic rhinoplasty . A preservation technique could also have been considered, but with such a low radix, I'm very cautious: some preservation techniques, primarily the low-strip SPQR , can lower the radix even further. Structural rhinoplasty allows for reconstruction of the dorsum from the appropriate point and, incidentally, correction of the deviation.
What I did during surgery
A structural ultrasonic rhinoplasty with septoplasty and turbinate reduction: I grafted the radix with cartilage powder and fibrin-rich plasma, reconstructed the dorsum with spacer grafts, and mounted the tip on a septal extension graft. General anesthesia (TIVA type), three hours, and one night hospital stay.
What is observed in the result
At one year, the back is straight and starts at the correct height, the tip is no longer bulbous or drooping, and the deviation to the left is corrected.
More cases and an explanation of the technique can be found on the rhinoplasty page in Madrid.
Case operated on by Dr. Gustavo Sordo
Specialist in Plastic, Aesthetic and Reconstructive Surgery. Member No. 282858125.
Regarding this intervention
Not all noses need ultrasound, nor do they all benefit equally. In our ultrasonic rhinoplasty guide, we explain in which cases the outcome varies.
Do you want to know if this can be done in your case?
The first consultation is with Dr. Sordo, either at the Chamberí clinic or via video consultation. You'll leave knowing if you're a candidate, which technique is right for you, and how much it costs.
Dr. Gustavo Sordo · Member No. 282858125 · Plastic, Aesthetic and Reconstructive Surgery · Madrid