Fixing Obtuse Nasolabial Angle

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?

Doctor Answers 7

Fixing a high nasal tip can be accomplished with cartilage grafts

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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.

New York Facial Plastic Surgeon
4.9 out of 5 stars 141 reviews

Nasolabial angle reduction

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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.  

William Portuese, MD
Seattle Facial Plastic Surgeon
4.8 out of 5 stars 158 reviews

Obtuse Nasolabial Angle

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Decreasing tip rotation can sometimes be achieved by repositioning the tip cartilages. However, cartilage grafts from the septum or ear are usually necessary. See a physician experienced in revision rhinoplasty  because the procedure can be surgically challenging. 

Richard W. Fleming, MD
Beverly Hills Facial Plastic Surgeon
4.9 out of 5 stars 43 reviews

Nasolabial angle

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  • 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

Jason Hess, MD
San Diego Plastic Surgeon

Fixing an obtuse nasolabial angle

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There are rhinoplasty procedures that can correct an upturned nose but a thorough exam would be critical. 

Steven Wallach, MD
New York Plastic Surgeon
4.2 out of 5 stars 30 reviews

Revision Rhinoplasty to achieve nasal lenghthening would be a difficult undertaking.

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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.

Eric M. Joseph, MD
West Orange Facial Plastic Surgeon
4.9 out of 5 stars 435 reviews

Think carefully before embarking on secondary rhinoplasty

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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".

Thomas Buonassisi, MD
Vancouver Facial Plastic Surgeon
4.9 out of 5 stars 114 reviews

These answers are for educational purposes and should not be relied upon as a substitute for medical advice you may receive from your physician. If you have a medical emergency, please call 911. These answers do not constitute or initiate a patient/doctor relationship.