Turned up nose or over-rotated nose is commonly seen after an aggressive reduction rhinoplasty followed by tissue contracture, but can also exist for patients who never had any nasal surgery in the past. There are several options both non-surgical and surgical, depending on one's anatomy.
Non-surgical (limited): If the dorsum (bridge of the nose) is concave (sloped), adding fillers such as Radiesse can give an allusion of a longer nose (nasal lengthening). This however, will do very little for the nostrils that are visible.
Surgical: Correction of an over-rotated nose is one of the most difficult procedures for any facial plastic surgeon. Several things need to happen for a succesful outcome. First, there must be enough skin to drap the lengthening of the nose. To accomodate this, patients will be asked to exercise stretching of the skin by pulling on the nasal skin for several weeks. Second, an augmentation is often necessary by using an implant (rib, gore-tex etc) to address the sloping of the dorsum. Lastly, a de-rotating (less turning -up) tip grafts or tip extension grafts are necessary not only to lengthen the nose but also to show less of the nostrils.
This type of surgery should be reserved for the most experienced rhinoplasty surgeons.
