How to Correct Upturned Tip After Rhinoplasty?

Question

I had primary Rhinoplasty 1 year ago and I regret it. Before the Rhinoplasty, I had stronger and symmetrical nose and I was very satisfied with my face. After operation, my nose is more feminine in profile, but tip is little bit upturned and I don't like it. The result is not bad and drastic. I think my old nose was better balanced and I would like to consider revision and rotate my tip down. Also, I am very sceptical about adding cartilage because I have heard cartilage can warp with time. Any suggestions? Thanks.

Eric M. Joseph, MD · Answer

Dear Zoya,
If you post a picture, we'd all be able to give you better suggestions. Rotating the tip down is not easy, and in my hands, unpredictable. Unless you're severely over-rotated, gravity will slowly work in your favor.
If the appearance of your profile is too feminine, sometimes it's because the bridge is a bit low. Raising the bridge can be done effectively with permanent injectable fillers in the office.
I hope this is helpful, and best regards.

Oakley Smith, MD, FRCSC · Answer

There are a few techniques available to reverse an overly rotated nasal tip. Since cartilage was likely removed to rotate the tip during the first surgery, this cartilage will likely need to be replaced during the revision surgery. The best cartilage is whatever septal cartilage remains. Ear cartilage is a distant second best. There are methods of altering the position of the remain tip cartilage to de rotate the nose but these are not as powerful and likely won't be enough.

Boris M. Ackerman, MD · Answer

Revision rhinoplasty surgery requires significant experience and talent on the part of your surgeon.  It is not uncommon in the patient with an apparent upturned nose to have some other postoperative imbalances that need to be corrected.  Only a highly qualified Rhinoplasty surgeon can make that assessment and give you a correct recommendation.

	As to the actual technique, there are a few, depending on how many nasal surgeries you had, the amount and quality of autologous cartilage, etc.  Typically some form of tip graft is required, in addition dorsal lengthening technique might need to be used, assessment and correction of nasal spine, etc.  The most important thing is that your surgeon has a clear idea as to what is causing  your apparent upturn nose and having a clear cut surgical plan and the ability to execute that surgical plan.

Toby Mayer, MD · Answer

Lengthening a short nose requires more expertise and experience than removing a bump from the nose. Grafts of cartilage and skin are usually required and come from the septum or ear. See good before and after pictures and talk to a patient that has had this done by the doctor. My patients who have had this done as well as other experienced surgeons don't mind doing this.

Behrooz Torkian, MD · Answer

Hi Zoya,
The upturned tip can be corrected with cartilage grafts from the septum or the ear. 
Generally, your surgeon will find other things that can be improved during your revision.  If indeed the only necessary alteration is to decrease the tip rotation, I would recommend giving the first chance to your original surgeon. He/she is very familiar with hs/her own surgical style, and may be able to easily correct such a small deformity with a touch-up procedure.
Good luck.

David C. Pearson, MD · Answer

Lengthening an over-shortened nose is always difficult, in part due to the contracted skin/soft-tissue envelope of the nose. Caudal extension grafts and extended spreader grafts can be used successfully. The best tissue for this is usually septal cartilage (from the mid-line partition of the nose), but if that's inadequate, then a patient's own rib cartilage is terrific and--properly cut--is unlikely to warp.

Michael A. Persky, MD · Answer

Hi Zoya,
Your own cartilage (from your nasal septum or ear) is the best, most reliable material to augment your nose with.  Medpor makes a very nice nasal implant that has worked very well in my practice to augment the nose.  To correct the tip that is too superiorly rotated will require using grafts.  Same goes correcting the feminine dorsum.
Discuss your concerns with your rhinoplasty surgeon.  Good luck and be well.
Dr. P

David C. Mabrie, MD · Answer

Frequently after an unsuccessful  attempt at surgical rhinoplasty, patients are hesitant to have another procedure performed.  Using fillers for non-surgical rhinoplasty may be an excellent option.  Placing fillers can be performed with less risk and trauma than another surgery and with less cost.

	Are there risks?   Yes, as there are with surgery, however non-surgical rhinoplasty can have fewer risks than surgery if performed by a specialist.  Carefully research your provider, looking for example cases similar to yours.

	Good luck in your search for information!

Robert Mounsey, MD · Answer

The nasal tip is a complex area and revision on this area should only be attempted by experienced rhinoplasty surgeons. The proper diagnosis is essential. Consult an experienced rhinoplasty surgeon. That person will need to do a very precise exam to document the problem and formulate a solution.

Pat Pazmino, MD, FACS · Answer

Today, there are many excellent techniques that can be used during a revision rhinoplasty. If you feel that the tip of your nose is rotated too high, this may be corrected with a revision rhinoplasty. Your surgeon may remove a small portion of cartilage, maybe position your nasal cartilages, or may add small pieces of cartilage graft to change the appearance of your nasal tip. As you can imagine, this can be a complicated surgery so your best bet is to only work with a board-certified plastic surgeon who has a great deal of experience in rhinoplasty, revision rhinoplasty, and a variety of cartilage grafting techniques.

How to Correct Upturned Tip After Rhinoplasty?

Answers (12)

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