Dropping the nasal tip

Without all photographic views, including the base view (the one from below the nose looking up at the nostrils) I can not give you a specific plan to accomplish your goals. However, several options are present to derotate or drop your tip.

1) shaving the bottom of the septum can sometimes allow the tip to drop. Since it appears you do not need a lot in that regard, this might work well for you and would probably be my choice in your case.

2) trimming the tip cartilages right where they meet your upper lip can also produce derotation.

3) removal of bone near the base of your septum can add additional derotation if desired.

4) formal tip surgery involving sutures can be used to change the overall angulation to your tip. This can be tricky and I would not recommend this unless you need significant narrowing of the tip when viewed from the front.

May options exist and, if your surgeon is experienced in Rhinoplasty, whichever one he or she chooses will be based on their own past experience and success.

Good luck.

Hello ajl,

Very good advice given to you here.

I agree that it is difficult to give comprehensive advice to you without additional photos or a chance to exam your nose in person.

I also agree that in most cases downward rotation of the nasal tip is best accomplished by removing cartilage from the nasal septum (the rubbery wall between your right and left nasal cavities). Cartilage removal from the tip can be done but is indicated only for select types of anatomy.

Sounds like you still have some questions about your surgery - it would be worthwhile to have another consultation with your Surgeon or have another opinion.

Always best to have all of your questions answered and a clear understanding of your surgery prior to proceeding.

I am assuming that you had a prior Rhinoplasty. There are several techniques to "derotate the tip." This can include work through an incision placed within your nose to free the soft tissue and tip from the septum (using a transfixion incision), and using sutures to reduce the height and length of the tip.

Sometimes cartilage grafts can be inserted as what are called extended spreader grafts or tobaggon grafts to advance the nose. Sometimes, addding a graft at the base of the septum can help as well. Without a careful exam and review of multiple view photos it is difficult to give you a specific answer.