Under Projected Nose

Dr Jason Roth (MED0001185485) — Specialist Otolaryngologist & Head and Neck Surgeon, specialist registration in Otorhinolaryngology, Head & Neck Surgery.

All cosmetic surgery involves risks and individual results vary. Cosmetic surgery is a serious decision. Decisions about whether to proceed should be made after careful consideration and following at least two consultations with a qualified medical practitioner.

An under-projected nasal tip sits closer to the face than is proportionate, giving the nose a flattened or poorly defined appearance in profile. It may occur as a primary feature, or as a consequence of previous surgery or injury that has destabilised the structural support of the nasal tip.

All surgery carries risks — read the full rhinoplasty risks page →

What Causes Under-Projection?

Primary (congenital) — some patients are born with a tip that has insufficient cartilage strength or support to maintain adequate forward projection. This may be related to weak lower lateral cartilages, an under-developed columellar strut, or a short caudal septum.
Post-rhinoplasty — over-resection of the lower lateral cartilages or inadequate reconstruction of tip support during a previous rhinoplasty is a common cause. When too much cartilage is removed, the structural integrity of the tip is lost and it collapses over time.
Post-traumatic — nasal injury can disrupt the cartilaginous supports of the tip, leading to loss of projection during healing.

Surgical Treatment

Increasing tip projection reliably requires cartilage grafting — the new position of the tip must be structurally supported if it is to be maintained long-term. Sutures alone are generally insufficient to hold the tip in an augmented position against the forces of gravity and scar contracture over time.

Columellar strut graft

A straight piece of cartilage placed vertically between the medial crura (the central limbs of the lower lateral cartilages) to provide a stable foundation for the tip. This is one of the most commonly used techniques for augmenting tip projection and support.

Caudal septal extension graft

A graft stitched to the front edge of the nasal septum to extend its length and push the tip cartilages forward and downward. Provides a very stable platform for repositioning the tip — particularly useful in revision rhinoplasty where the tip has fallen back significantly.

Tip grafts

Shield grafts or cap grafts placed at the nasal tip to augment projection and definition. Used in selected cases where structural reconstruction is not the primary requirement.

Graft sources

Grafts are most commonly taken from the nasal septum (first preference) or from rib cartilage where larger volumes are needed — particularly in revision cases where septal cartilage has already been harvested.

Increasing tip projection is technically demanding, particularly in revision cases where previous surgery has altered the anatomy and reduced available graft sources. Realistic expectations regarding what can be achieved are discussed in detail at consultation.

Dr Roth’s Clinical Perspective

Under-projection is one of the rhinoplasty concerns where the consultation photography is most useful — many patients are not sure whether their concern is under-projection, a wide tip, or a combination, until the basal and lateral views are reviewed together. Increasing tip projection changes multiple nasal relationships simultaneously: it increases the apparent length of the nose, changes the nasolabial angle, and affects the columellar-lobular relationship. Planning these changes carefully before surgery is essential to avoid over-correction in one dimension while improving another.

— Dr Jason Roth, MBBS, FRACS (ORL-HNS), IBCFPRS

Dr Jason Roth — Specialist Otolaryngologist Sydney

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Speak with Dr Jason Roth

Dr Roth consults from Dee Why on Sydney’s Northern Beaches. A GP referral is recommended.

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(02) 9982 3439

Dr Jason Roth (MED0001185485) — Specialist Otolaryngologist & Head and Neck Surgeon.

Dr Jason Roth | MBBS, FRACS (ORL-HNS) | MED0001185485
Specialist Otolaryngologist & Head and Neck Surgeon
Specialist registration — Otorhinolaryngology, Head & Neck Surgery
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