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THE SEVERELY TWISTED NOSE

LECTURE ON OSTEOTOMIES

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 ยป Septum Needs Shortening

Septum Needs Shortening

If the septum needs shortening, this may be a good time to perform selective excision of the caudal aspect of the septum (Figure 3). If rotation of the nasal tip is neces­sary, a superiorly based triangle of caudal septum can be

Figure 4. Maintain a generous L-strut.

excised. For an obtuse nasolabial angle, the posterior sep­tal angle can be trimmed. For a tension nose deformity12 or hanging columella deformity, the entire caudal septum may need to be trimmed. In place of resection, an overly long midline caudal septum can be sutured between the medial crura to provide support, increase projection, and set tip rotation and alar-columellar relationship.

Figure 5. The "doorstop" technique described by Pastorek and Becker.13

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