Revision Rhinoplasty for Severely Overturned Nose? (photo)

It's been 15 years since my original rhinoplasty. I am wondering if there is anything that can be done to lengthen my over rotated nose? Not only am I unhappy with the profile, as you can see from the front view, my nostrils are prominent and i have a hanging columella. How can this be corrected? Is it a difficult procedure? What can I expect the cost to run?

Doctor Answers 13

Revision Rhinoplasty for Severely Overturned Nose?

 From the photos provided your nasal tip is severely over rotated.  The nasal tip can be made to appear less rotated by combining a Columellar tuck procedure with some tip lengthening techniques during a Revision Rhinoplasty.  You should have several consultations with experienced Revision Rhinoplasty Surgeons and IMHO, expect the cost to be between $10,000 - $15,000.

Beverly Hills Facial Plastic Surgeon
4.5 out of 5 stars 17 reviews

Revision surgery to correct severe upturned nose

Yes, it is possible to improve your tip position and upturned appearance. This is complex surgery so you want to make sure your surgeon has experience treating this type of problem.

Cartilage grafting is typically required to reposition and stabilize the nose during surgery.

You can read more about upturned nose correction at my web reference link below.

Thomas A. Lamperti, MD
Seattle Facial Plastic Surgeon
5.0 out of 5 stars 19 reviews

Correcting the over-resected, over-rotated nose with revision rhinoplasty

Your nose can certainly be improved with a revision procedure.  The tip of your nose has been significantly over-rotated (pushed up), and so a septal extension graft will likely be needed to push it back down to a more attractive position.  By pushing the tip of your nose down (counterrotation), it will reduce the prominence of your nostrils from the front.  Based on your pictures, you will need quite a bit of cartilage to reconstruct your nose, so rib cartilage harvest is likely necessary.  For an experienced revision rhinoplasty surgeon your case is commonly encountered.  

Donald B. Yoo, MD
Beverly Hills Facial Plastic Surgeon
5.0 out of 5 stars 41 reviews

Revision rhinoplasty

Improvements can be made with a revision rhinoplasty. Grafts can be used to improve the appearance of your nose, and it would be best to seek the advice of a board certified revision rhinoplasty specialist. He or she may use computer imaging software to give you an idea of how the final result may appear. Cost of a revision can vary depending on the individual circumstances of the patient. Look for a board certified surgeon who has great patient testimonials and many before and after photos, I hope this helps, and best of luck to you. 

Paul S. Nassif, MD
Beverly Hills Facial Plastic Surgeon
5.0 out of 5 stars 42 reviews

Over rotated tip

It does not look like you have a hanging columella. You have an over-rotated tip and grafts would be needed in an attempt to derotate it.  Good luck.

Steven Wallach, MD
New York Plastic Surgeon
4.0 out of 5 stars 23 reviews

Rhinoplasty to Lengthen Nose

The nose can be lengthened to rotate the nasal tip downwards to create a more natural appearance by using cartilage from your own body.  By doing so, the appearance/location of the columella will also usually be improved as will your nostrils.  While revision surgeries are always more extensive than primary ones, you want this to be your second and last surgery, so finding the right surgeon who shares your aesthetic goals and eye with the most advanced surgical techniques is critical.  Please consult with a board certified specialist who can best assist you in achieving the results you seek.


Kimberly Lee, MD
Beverly Hills Facial Plastic Surgeon
5.0 out of 5 stars 9 reviews

Revision rhinoplasty

This can be correct, but it will require extensive grafting.  Typically, this will require cartilage grafts from your ear or rib to lengthen and de-rotate your nose.  Your surgeon should be experienced in revision rhinoplasty surgery.   You will need to spend a significant amount of time reviewing your expectations against possible surgical outcomes.  Good luck with your search.

Craig S. Murakami, MD
Seattle Facial Plastic Surgeon
5.0 out of 5 stars 2 reviews

Revision for Severely Over-rotated Nose

This problem can be corrected with cartilage grafts but it is a difficult procedure. I encourage you to have the surgery as long as it is done by a revision specialist.

Richard W. Fleming, MD
Beverly Hills Facial Plastic Surgeon
5.0 out of 5 stars 32 reviews

Revision rhinoplasty

You have described yourself well. You do have a shortened over rotated nose with a lot of nostril show.  All of these problems are correctable with a revision. A variety of techniques including the use of cartilage and possibly composite grafts will be necessary to correct this. You need to have consultation with rhinoplasty surgeons that are experienced with this kind of problem and do it regularly. Ask to see photos of revision patients like yourself and see how they came out.  Revisions of this type are usually more expensive then routine rhinoplasty. This is due to complexity and increased operative time. This is not the time to look for the least expensive option as that may get you into worse shape. While prices vary I would guess that a range of $8-12,000 would exist for total cost. Good luck.

Michael L. Schwartz, MD
West Palm Beach Facial Plastic Surgeon
4.5 out of 5 stars 8 reviews

Severely Overturned Nose


   Thank you for providing photographs with your question.  It makes having a meaningful discussion about your concerns a little more realistic. 

   Scooped bridges, over-rated and pinched nasal tips were much more common 15 years ago then they are today.  Rhinoplasty techniques have evolved and I like to believe that most surgeons currently performing this procedure recognize that smaller is not always better. 

   For many people with over-rated nasal tips they can frequently find significant improvement with revision rhinoplasty.   That being said, lengthening a foreshortened nose is one of the most challenging components of revision rhinoplasty.  It almost always requires the use of rib cartilage to create a number of grafts to rebuild your nose. 

  Improving the rotation of the tip of your nose,  the hanging columella and the visible nostril show on front view can all be achieved with revision rhinoplasty.  These are advanced techniques and I would recommend meeting a surgeon  that specializes in noses and has a large volume of revision rhinoplasty.  During a consultation your surgeon can assess the tightness of your nasal skin which is commonly the rate limiting factor to how much length and rotation can be achieved. 

Hope this helps.

Christopher Kolstad, MD
San Diego Facial Plastic Surgeon
5.0 out of 5 stars 50 reviews

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.