Is It Possible to Correct an Over-Rotated Tip?

Question

I had a primary tip augmentation rhinoplasty and think the tip is over-rotated. I understand I should wait a year before any corrective procedures. However, just curious. Usually how much derotation is possible? I heard skin is the limiting factor, but in your experience, what is a reasonable/average amount of derotation possible in mm? Thanks

Thomas A. Lamperti, MD · Answer

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.

John M. Hilinski, MD · Answer

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

Matthew Bridges, MD, FACS · Answer

There are definitely rhinoplasty maneuvers that can be used to rotate a tip down. Some are simple and some are not. It depends on the degree of over-rotation, the skin, available grafting material, what was done in previous surgery, etc. Take a look at my photos in Realself. There is a patient who had quite an upwardly rotated nose that required special grafts to "push" the tip down. You can see from the photos that significant downward rotation is definitely possible. To answer your question, I'm not sure there is a maximum amount that can be achieved. I think in general, however, that 4-5mm is reasonable to achieve.

William Portuese, MD · Answer

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.

Richard W. Fleming, MD (retired) · Answer

An over-rotaed tip can be corrected. Many different techniques, from simply repositioning of the tip to placement of cartilage grafts, are used depending on each individual patient's needs. Skin is rarely the limiting factor but intranasal scarring or a lack of nasal lining are sometimes a problem.

Daniel Greenwald, MD (in memoriam) · Answer

Tip position is critical to nasal aesthetics.  Over-rotation is becomming more common as more and more doctors expand into the arena of cosmetic surgery.

	De-rotation requires skill and experience.  If you find the right surgeon you can expect significant improvements with revision.

Francis R. Palmer, III, MD (retired) · Answer

Yes, sadly this is a common question being asked on this forum lately in regards to Rhinoplasty. Pictures, of your nose from the front and profile would help in the evaluation but there are ways to rotate the nasal tip down to the proper aesthetic position during Revision Rhinoplasty.

Is It Possible to Correct an Over-Rotated Tip?

Answers (7)

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