Fixing Obtuse Nasolabial Angle

The simple answer is yes, is it possible to de-rotated the nasal tip (make the nasal labial angle more acute) during a secondary rhinoplasty. While it is ideal in men to have an angle between 90 - 100 degrees (depending on your height), it is not uncommon to be outside this range and still look very good. The best way to de-rotate the nose is to essentially push the nasal tip downward by extending the nasal septum. Cartilage is required and may be harvested from the nasal septum itself, the ear or even the rib.

 

Having said all of this, this may be more surgery than you wish to undertake given that you seem happy overall . It is very difficult to completely correct an over rotated nose. Please consider this option seriously and make sure that you really can't live with your current results. There is an old saying in surgery, which I think applies here: "The enemy of getting a good result is trying to get a perfect one".

To try to reduce the nasolabial angle is difficult in revision rhinoplasty. There are multiple techniques available to the rhinoplasty surgeon, such as dorsal grafting and extended spreader grafts to try to push the tip downwards. In addition, if there is excess columella show, the columella can be trimmed posteriorly in an attempt to derotate the tip.