An over projected (or overprojected) nose refers to a nasal tip that, simply put, sticks out too far from the face. There are a variety of methods to objectively assess and measure nasal tip projection. Probably the most commonly method is the one developed by Dr. Richard Goode from Stanford. The Goode method involves measuring the patient’s tip projection and comparing this to the length of the nasal bridge. If this ratio is greater than 0.55-0.60, the nose is considered to have an excessive amount of tip projection. The reality is that most experienced rhinoplasty surgeons do not actually measure this on a regular basis. Instead, most rhinoplasty experts will be able to determine whether or not a nose is overly projected based on a gestalt visual assessment.
Appearance of an Overly Projected Nose
In many cases of an over projected nasal tip the entire nose may appear too large for the face. In fact, many rhinoplasty patients present to the office complaining their nose is just too big.
In these rhinoplasty patients, the nasal tip extends out too far in addition to the nasal bridge being excessively high as seen on the profile view. This is demonstrated in the adjacent patient photograph where the red arrow indicates nasal tip projection and the blue arrow indicates bridge height. The red vertical line represents the plane of the face. In this particular patient example, the nasal tip is overly projected from the face, but the bridge height is also excessive. When this occurs in combination, it can sometimes hide the fact that the nasal tip is truly over projected since the nose just looks too big overall. Regardless, if you look specifically at the nasal tip, you will appreciate the fact that the nose is over projected, or sticks out too far from the face.
In other rhinoplasty patients, the nasal bridge height is normal and just nasal tip is excessively projected outward from the face. This type of over projected nose is demonstrated in the adjacent photo example. This patient has a congenitally over projected nasal tip with a relatively normal nasal bridge height. Even to the untrained eye, it can be appreciated that the tip of her nose is positioned too far out. Some people might question whether or not there is an actual depression above the nasal tip region as it transitions to the bridge. However, if you look closely you will realize that this appearance is, indeed, a direct result of the nasal tip that is projected out too far from the plane of the face.
Anatomy of an Overly Projected Nose
So what is behind an overly projected nasal tip? Essentially it is the lower lateral cartilage of the nose that contributes directly to the shape and position of the nasal tip. The lower lateral cartilage refers to the pair of cartilage structures that comprise the lower one-third of the nose. This is demonstrated in the adjacent diagrams as seen on profile view. The red shaded area on the left indicates the normal shape and position of the lower lateral cartilage. On the right is an overly projected lower lateral cartilage. Comparing the two diagrams, you can easily appreciate how the overly projected nasal tip cartilage sticks out too far from the bridge. This is precisely what contributes to the nose looking too large.
Rhinoplasty For An Over Projected Nose
Rhinoplasty surgery for an overly projected nose focuses on bringing the nasal tip closer to the face. Simply put, this involves making a large nose smaller. This type of nose reshaping primarily involves work on the lower lateral cartilage.
In some cases, the entire lower lateral cartilage can be detached from the remainder of the nose and repositioned closer to the face to achieve cosmetic improvement. In other patients, just the tip of the lower lateral cartilage needs to be reshaped. This can be done by incising (cutting) the nasal tip and overlapping the cartilage (called a lateral crural overlay) or by simply truncating the tip of the lower lateral cartilage.
If the nasal bridge height is also excessive, then reduction of the dorsum may be undertaken at the same time to make the entire nose smaller.
Deprojection of the nasal tip can be accomplished through either an open rhinoplasty or closed rhinoplasty approach.
These varied methods of reshaping the nasal tip are all considered proven and reliable techniques to address an overly projected nose. However, there are certain situations where one technique should be chosen over the others. For instance, if an over-projected nose also needs to have the nasal tip rotated upward as part of the surgery, perhaps the lateral crural overlay technique may be the better option. The ultimate choice of technique should be left to the rhinoplasty specialist who will decide based on their individual preference and experience in context of the nose that is being reshaped.
Examples of Deprojection of the Nose
The following photos represent cases of deprojection of the nasal tip performed by Dr. John Hilinski. In each case you can appreciate the fact that the tip has been brought closer to the face with or without reduction of the nasal bridge height.
Example 1
Example of rhinoplasty for nasal deprojection while also reducing the nasal bridge height. In this particular case, the entire nose was made smaller by bringing the tip closer to the face in conjunction with rasping the bridge down in size.
Example 2
Example of rhinoplasty for nasal deprojection focusing primarily on just the nasal tip that stuck out too far. In this particular case, the bridge height was not a significant problem. By deprojecting only the nasal tip, a more balanced profile view was able to be achieved.
Example 3
Another example of nasal deprojection concurrent with reduction of the nasal bridge height. Similar to the case above, the entire nose was made smaller by bringing the tip closer to the face in conjunction with rasping the bridge down in size.
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