Is It Possible to Correct an Over-Rotated Tip?

There are several techniques to counter rotate the nose. After prior rhinoplasty contracture of the overlying skin can be a limiting factor to rotating the tip down. This is one reason to give the nose time to heal and the scar to soften to help promote as much movement is possible. Another limitations include how much cartilage was resected during the original surgery.

It's is hard to give a precise amount of movement that is possible, but in general several millimeters may be able to be achieved.

It is possible to correct an over rotated tip with different revision rhinoplasty techniques.  These techniques include extended spreader grafts and trimming back the most inferior portion of the columellar septum.  Dorsal augmentation and/or a full transfixion incision on the columella will also help with this problem.  Usually 3-4 mm of derotation is possible, but it all depends upon the scar formation on the underneath side of the nose and the current cartilaginous structure.  

The answer is - it really depends on a number of factors. This includes the condition of your skin and whether or not there is any significant scarring of the overlying soft tissue as a result of the prior rotation process. It also depends on how much reshaping of the underlying cartilage was undertaken and if there was any significant amount of cartilage taken out during the first surgery. Make sure you find an well-trained revision rhinoplasty expert who has defined experience in managing this type of 'short' or 'overly rotated' nose. Make sure to see several photo examples of their work demonstrating this exact type of surgery. This is one of the most challenging, complex types of revision rhinoplasty - therefore, finding the right surgeon is of utmost importance. Good luck. Dr. Hilinski