Treatment of over-reduction of the nose and subsequent deformities

Failures after rhinoplasty are the result of both technical mistakes and of errors of judgement. One of the most common errors is resection of too much tissue from the components of the nose: the dorsum, alar cartilages, or septum. Such deformities may have both cosmetic and functional effects. The defects that most commonly make a nose look unnatural are: a shallow nasofrontal angle, a nose that has been shortened too much, an over-reduced dorsum which emphasises a parrot's beak deformity, and a round nasal tip with a short interdomal length that lacks definition. The purpose of this paper is to describe the most common deformities associated with excessive resection of the nose, and to suggest the appropriate procedures for correcting the defects. Grafting is usually necessary. We will deal first with deformities of the dorsum and septum and then of the nasal base, but it must be borne in mind that a defect in one area is likely to affect the other areas because they are interrelated-for example, over-resection of the dorsum may also effect the tip of the nose. In addition, not all deformities are the result of excessive reduction; some may result from inadequate resection.