Primary Rib-graft Rhinoplasty to Fix Upturned Nose? (photo)

I have a naturally upturned nose and my nostrils are visibly shown, especially if I am directly facing someone directly. Try to imagine Miss Piggy.. My PS said that he would augment my low bridge along with lengthening and defining my nose tip . How would he go about this and is the photo I have supplied achievable? (left is my current nose and right is something I would like to have postop - no nostrils visibly shown except a slight hint) Any comments would be greatly appreciated! Many thanks!

Doctor Answers 11

Grafting in an upturned nose

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In general, I would be very hesitant to perform rib-grafting in a primary rhinoplasty.  Cartilage grafting may acheive the results you are looking for.  With an upturned nose, I prefer a closed rhinoplasty approach.  Although more difficult, it obviates the scar on the columella, which may be readily visible. I would recommend obtaining more than one surgeon consultation prior to any surgery.

Rhinoplasty to fix upturned nose

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The after photo shown is not obtainable.  It is best to undergo dorsal augmentation with either the patient’s own nasal septal cartilage or a small silastic implant.  The nose will not become downturned as shown in the picture.  This is an unrealistic expectation.

Correcting An Upturned Nose

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Dear Prorsum,


Based on your photo you can benefit from a tip lengthening, narrowing of the nostrils and your nasal dorsum will be addressed to be coherent with the changes. In other words, you will need to consider a multifaceted rhinoplasty.

That said, there are multiple ways to provide you with similar results presented in the projected "to be" photo.

I encourage you to seek consultation with different surgeons of extensive experience in that field to be able to make a well informed decision.

Thank you for your questions and the best of luck to you.

Dr. Sajjadian

Treating an upturned nose

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The cartilage grafting is used to support and rotate the upturned tip downward while at the same time building up the bridge itself. Your supplied morphing is a possible result.

You can check out my link below where I discuss congenital upturned tip surgery in more detail.

Fixing Upturned Nose

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Your nose can be lengthened with cartilage grafts taken from the septum which is a technique I have used for 35 years. The result you submitted is reasonable. A profile view or an examination of your nose would help us make specific recommendations.

Richard W. Fleming, MD
Beverly Hills Facial Plastic Surgeon
4.9 out of 5 stars 40 reviews

Correction of nasal rotation

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Thank you for the question and the photos. Although the photo is limited but, what your plastic surgeon described is appropriate. The question is, is the results will match the photo you presented. It is good that you brought it up, but you have to have realistic expectations. 

Moneer Jaibaji, MD
San Diego Plastic Surgeon

Miss Piggy

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Nasal Lengthening is an art to behold.  There are about nine different ways to surgically lengthen the nose and they all have an up & down side.  Consult with three different Cosmetic Surgeons to gain a feel for your needs.


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I think it is an achievable goal if you also put cartilage grafts in the tip of the dome. Since you would need some delicate tip work it is problem best done as an open procedure. A graft or implant is placed on the bridge and the tip cartilages are placed over and above the end of the bridge graft/implant. Then the tip cartilages are trimmed and a shield shaped graft placed on top of them to simulate the 2 light reflecting points visible in the dome of the nasal tip in the right photo.

My response to your question/post does not represent formal medical advice or constitute a doctor patient relationship. You need to consult with i.e. personally see a board certified plastic surgeon in order to receive a formal evaluation and develop a doctor patient relationship.

Aaron Stone, MD
Los Angeles Plastic Surgeon

Rib graft or septal cartilage to lengthen nose.

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Rib graft or septal cartilage to lengthen nose. I use septal cartilage for this and NOT rib which is much more painful, leaves a scar and costs a lot more.

Toby Mayer, MD
Beverly Hills Facial Plastic Surgeon
4.8 out of 5 stars 36 reviews

An implant of some type is required to fix an overly upturned nose.

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Something (an implant) needs to push the nose further down in 3 dimensional space to fix an upturned nose.  Bone grafts (rib and calvarium) have been used as well as rib cartilage.  I prefer, in most cases, Medpore since there is no donor site and I have had very good success with it.

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.