Upturned nose after rhinoplasty - Can it be brought back down to previous angle? (photos)

Question

I had a rhinoplasty performed and had only requested for my nasal hump to be removed (2.5mm was taken off) and I had asked for narrowing of my bridge. I am happy with both those aspects of my surgery, however, my nose tip was lifted and now is on an upwards angle. My nose tip was also shorted via shortening of the anterior septum by 1.5mm.. no grafts were used and 6.5mm of LLC remain. Can my nose be counter rotated down and projected to waht I had before or closer to a 90 degree downward/angle

Eric M. Joseph, MD · Answer

Your 95 degree nose-lip angle looks good, and your tip will lower with time and gravity .Since you're overall pleased, and since tip lowering is unpredictable, it may be best to live with your results. Hope this helps! Dr Joseph

Alan Gonzalez, MD, FACS · Answer

Hello @revisionrhinosearch_90degree, thank you for your question. When planning a surgical procedure, it is important to have a consultation and take into account your expectations as well as what the specialist can do. In a rhinoplasty procedure, the nose as a whole must be treated to create harmony, not just one part. It is essential to have a balanced approach, considering both the aesthetic and functional aspects of the nose. Best wishes! Alan Gonzalez MD, FACS. American Society of Plastic Surgery Member (ASPS), International Federation for Adipose Therapeutics and Science” Member (IFATS), Colombian Society of Plastic Surgery member (SCCP).

Steven Curti, MD · Answer

Depending on the rhinoplasty technique used by your surgeon the nasofacial angle will change somewhat after surgery. Many times I over rotate the angle by 5-10 degrees knowing that, as it heals and swelling reduces, it will fall into place during the first couple months after surgery. There are certain massages that your surgeon can teach you to help this settle in the post operative period. If this persists beyond 12-18 months it may require a revision procedure.

Mark K. Markarian, MD, MSPH, FACS · Answer

Hello and thank you for your question.  Although an exam in person is ideal, from your photographs alone it appears that you can potentially benefit from sulbtle de-rotation of your nasal tip as your tip appears potentially over-rotated.  I would utilize extended spreader grafts for this surgery.  It also appears that you may have excess alar-columellar show and I would place extended alar contour grafts to improve this.   Further tip refinement may also be performed where the nasal tip cartilage is modified. Due to your prior rhinoplasty, the cartilage in your septum was likely harvested and so you will likely require MTF (cadaver) cartilage.  The modification of your nasal cartilage can be done with trimming, stitching or grafting.  If your septum is deviated and you have breathing difficulty, a septoplasty may benefit you as well.

The next step for you is to find the right aesthetic plastic surgeon.  In your rhinoplasty consultation, be sure your surgeon addresses all your aesthetic goals and concerns specifically, and discusses the surgery details including the position and size of the incisions used (with actual photographs and not just digital animations), the risks and benefits of the procedure, recovery time, and post-operative course.  Also, be sure to see plenty of before-and-after pictures in women who have a similar nose appearance to yours, and preferably at different time frames (3 weeks out, 3 months out, etc) to more accurately predict your own surgical outcome.

After seeking out a board-certified plastic surgeon who specializes in aesthetic plastic surgery, I think the most important component of the consultation is to establish a good connection with your plastic surgeon.  It’s the connection that allows you to clearly define your desired nose outcome goals, the first step of this whole process. If you don’t feel you have a good connection with your plastic surgeon after your consultation, he/she may not be the best surgeon for you.

For more information on rhinoplasty, please refer to my link below.

Good luck.

Mark K Markarian, MD, MSPH, FACS
Harvard-trained Board Certified Aesthetic Plastic Surgeon

David M. Kowalczyk, MD, MBA, FACS · Answer

Hello. Thanks for the questions. Yes, your nose can be downrotated and projected. It requires that a caudal septal extension graft be placed, the new angle measured, and the tip sutured into position. For subtle changes in angle and projection, it can be difficult to promise the exact outcome. But, improvements can be made if done properly. I would speak with your primary surgeon to determine if this is possible. If not, seek consultation with several others to learn how this can be accomplished. Hope this helps!

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