How to Lower Raised Tip After Rhinoplasty?

Hello,
There are risks associated with any surgery. It is difficult to determine exactly what your needs are without seeing additional photos and/or performing an examination. Thank you and best of luck.
Dr. Nassif

I would urge you to be cautious about your request. As soon as you lower the tip, it will seem as if the hump has returned. Drooping of the nasal tip or loss of  support is a common side effect of aging that causes older patients to appear as if they have a more prominent nasal hump. 

Lowering an over rotated nasal tip will involve several different surgical maneuvers. A thorough examination in combination with photographic analysis of your nose would be necessary to give you a good explanation of what would need to be done to fix your nose. Extended batten grafts are one of several procedures that have been used with good success, but, your problem may require addressing several other areas of your nose to give you an acceptable result.

 Usually this raised tip is the result of cartilage and or skin being removed. Therefore, these need to be replaced. Over the past 30 years I have seen many noses like this. Make sure you see an experienced rhinoplasty surgeon who is familiar with the techniques for doing this.

I would have to examine you in order to give a better opinion. However, there are indeed ways to lower the tip, or at least give an illusion of the tip being lower. Grafts, as you mentioned are but one approach.

There are many ways to drop and overly elevated or rotated tip after rhinoplasty. Some can be complex and others are very simple depending upon the degree of derotation that you are trying to achieve. While that may be one option and perhaps the best for you without actually seeing your pictures, there may be others available to you so you might want to ask your surgeon if he can do it another way or seek other opinions. I hope this information helps.

Since it has been a year from the prior rhinoplasty it is acceptable to undergo a revision rhinoplasty. There are many different techniques that can be performed to lower the tip. Bracing some of the upward tip rotation could be performed by weakening the support ligaments of the tip, which will effect a drop. Extended spreader grafts can be used and do not cause permanent edema. Sometimes an interposition graft between the upper lateral cartilage and the lower lateral cartilage will be done. Occasionally, composite grafts are used for alar layer and notching. Trimming of the columella, both membranous and cartilaginous components, is also done to shorten the nose in the vertical direction and push the tip down along the nasal spine.

I am sorry to hear of this experience. There are several ways to 'de-rotate' a nasal tip in revision surgery. Personally, I have performed this revision many times. It would be impossible for me to definitively answer this question for you specifically. There may be a miscommunication here, but batten grafts (?sp) may not be the answer. Several other options could exist. Perhaps you should seek a second opinion.

Your surgeon's suggestion of extended baton grafts is one solution. Usually the tip can be derotated best with an open rhinoplasty which allows proper exposure for the most accurate correction. Sometimes the tip can simply be adjusted with sutures, fixing it further down on the septal cartilage. Seek out another opinion with an experienced plastic surgeon.

The elevation of your tip is probably secondary to the removal of cartilage which should be replaced. The techniques for lengthening the nose have evolved over my 35 years in practice, but using your cartilage for appropriate grafts is necessary. I personally prefer the open technique for this surgery.