Fixing Obtuse Nasolabial Angle

Question

I had a rhinoplasty done about 1.5 years ago, and I am mostly happy with the results. As a male,my nose has a nasolabial angle that is too obtuse, and it looks too upturned you could say. I would prefer it to be more acute, such that the angle between the upper lip and the nose is closer to 90-100 degrees. Could this be done, and how hard of surgery is this?

Steven J. Pearlman, MD, FACS · Answer

An obtuse nasal-labial angle or an overly rotated nose can be fixed by using grafts of your own cartilage to lengthen the nose. The source of the grafts really depends on the state of your nasal septum. This is my first choice for lengthening noses. Otherwise ear cartilage or even rib in cases of very rotated noses can be used.

Jason Hess, MD · Answer

Yes, this is possible
	
		It is potentially as involved, if not more than your primary rhinoplasty
	
		Depending on your surgeon and your remaining cartilage, it may involve harvest of existing cartilage from your nasal septum, ear, or, less commonly, the rib
	
		It may involve what are known as "spreader grafts", to buttress the dorsum and lower the tip


	Because techniques differ among surgeons, it would be prudent to visit several to gain as much knowledge as possible to achieve your desired result.

	Hope this helps

	Jason Hess, MD

Eric M. Joseph, MD · Answer

It is theoretically possible to lenghthen your nose, derotate your tip, and close your obtuse nasolabial angle with cartilage grafting during revision rhinoplasty surgery. This is a difficult undertaking in the most experienced hands, so you should consult several reputable rhinoplasty specialists and view photos of similar patients before proceeding.

	I hope this is helpful for you.

Thomas Buonassisi, MD · Answer

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".

William Portuese, MD · Answer

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.

Fixing Obtuse Nasolabial Angle

Answers (7)