How to measure tip rotation if everyone has different philtrum/lip angles?

When we evaluate somebody's tip rotation, we evaluate the angle between the nose, and a perpendicular line dropped from the posterior columella straight to the floor. To your point, we do not strictly look at a nose philtrum angle. Hope this helps! Sincerely, Dr Joseph

Hello and thank you for your question. The specific manner in which tip rotation is measured doesn’t really matter. It matters much more how the nose fits with the individualized facial proportions, including consideration of patient goals. I recommend that you seek consultation with a qualified board-certified rhinoplasty surgeon who can evaluate you in person.

Best wishes and good luck.

Richard G. Reish, M.D.
Harvard-trained plastic surgeon

Nasolabial angle is most commonly described as the angle between the columella and the philtrum (upper lip), however you're right this may differ between individuals, so we normally take the ideal virtual vertical line starting at the lowermost point of the columella.

However, I prefer one less popular method, more realistic, accurate and easier to handle mentally, which is sizing the angle between the columella and the HORIZONTAL imaginary line starting at the bottom of the columella.

With the first method a horizontal columella would have 90º, which sounds misleading, and with the second method would be 0º, more realistic given this means has 0º of upwards rotation.

Hope this clarifies.

I do it by sight. In other words. I rotate it enough to make it look good. Exact angles are not really pertinent as far as I’m concerned. That’s why a surgeon needs to have an esthetic eye for these things

Bc that's what tip rotation is defined/based off of... you are correct that a more retrusive maxilla is going to give an impression of a more acute angle aka more counter-rotated. But that's what it is.