Hello Doctor. I have got a upturned nose at the end. Im looking for derotation only. The bridge and the upper 2/3 seems to be ok to me. Which options do i have? And which surgical techniques may i need? It also have a bulbous tip, but it doenst really bother me. Derotation is the most important thing for me. Do i need to know something before consulting ENT with rhinoplasty knowledge and much experience in my country. I know there are three very good. Frank, Netherlands
My Nose is Upturned at the End, Which Method Do I Need?
Doctor Answers (4)
Decreaasing Tip Rotation
There are several techniques to decrease tip rotation. Unfortunately, I cannot locate your pictures to evaluate your concern. The procedure can be as straightforward as mobilizing your tip and placing a suture to fix your tip in its new location or a more involved placement of a cartililage graft.
Sometimes simples things can de-rotate the tip. This can sometimes be done by a complete trans-fixion o release at the juncture between the septum and medial crural cartilages. Sometimes grafting can help as well.
Rhinoplasty techniques to correct upturned nose
One of the ways to help de-project and derotate the nose is to perform a dorsal augmentation with the patient’s own natural nasal cartilage. A full transfixion incision alone will also de-project the nose and allow the tip to droop slightly. In addition, the tip can also be slightly de-projected and derotated by placing a depressing stitch along the caudal septal margin to push the septum down. This can all be done through a closed rhinoplasty approach.
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From the photos I would say that your nose is not upturned. If on a straight frontal view you can see right into the nostrils then it is upturned and that is not the case in the photos. What I do see is an asymmetric tip and prominent tip cartilages that create stepoff edges where they meet the bridge. Trimming of the upper edge of the tip cartilages and then suturing the 2 cartilages together to create a symmetric construct should solve the issue.