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

Question

I see that people use nasolabial angle to measure tip rotation but how can this be accurate if everyone’s philtrums are at different angles which would affect the nasolabial angle even though the nose tip is not upturned. A deeper upper lip (angled more towards face) is going to create a more acute angle, a more flat upper lip (angled more outwards) is going to create a more obtuse angle. In both cases the tip rotation doesn’t change.

Eric M. Joseph, MD · Answer

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

Richard G. Reish, MD, FACS · Answer

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

Best wishes and good luck.

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

Alejandro Nogueira, MD · Answer

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.

Ronald J. Edelson, MD · Answer

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

Lexie Wang, MD · Answer

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.

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

Answers (5)

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