A successful rhinoplasty demands as much acumen in diagnosis as excellence in technique. For instance, failure to recognize the presence of an anatomic peculiarity (such as a short columella) may vitiate the most carefully elaborated craftsmanship.
To bring the above statements into sharper focus, we will discuss postoperative dropping of the nose.
In the reduction of nasal length* it is essential to produce an appropriate angle between the nasal base and the lip. This is achieved by tilting the lower nasal component upward and backward (cephalodorsally). To carry out the elevation of the lower component without tilting leaves the angle between the nasal base and the lip unaltered, causing a retracted columella, an overhanging tip, and a snub-nose (pugnose) effect—a deformity more unsightly than that produced by the excessive length3 (Fig. 1). To use Rethi's4 simile
FOMON S, BELL JW, SCHATTNER A, SYRACUSE VR. Postoperative Elongation of Nose. AMA Arch Otolaryngol. 1956;64(6):456–463. doi:10.1001/archotol.1956.03830180006002
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