Can an Upturned Nose Be Corrected?

Question

Considering (primary) r.p., but still uncertain if it's worth it, and would like some opinions on results, procedures, costs. My main concerns are the nasofrontal and nasolabial angle; how much can I realistically expect these be corrected in comparison to my current angles (acute vs. obtuse angles). Other concerns are bulbous tip, which I would like to see more refined, and columellar show. I want more projection and definition, but not a smaller nose (I don't think nostril reduction would fit)

Aaron Stone, MD · Answer

Your posted photos show an upturned nose with completely visible nostrils on a front view and a nose to upper lip (nasolabial) angle of about 125 degrees. The preferred angle in a male is 90 degrees. I suspect you will need a cartilage graft extending from the septum down between the right and left tip cartilages. The degrees of rotation can then be controlled by the way the cartilages are sutured together. You may also need removal of the nasal spine and reshaping of the bottom of the septal cartilage to achieve the desired result. In my opinion that would have to be an open rhinoplasty for the results to be reliable. I think you should be able to get close to the desired 90 degrees with this methodology.

	The main question would be where do you get enough cartilage with sufficient strength to do the job and you need to discuss that with your surgeon.
	
	Your nose to forehead (nasofrontal) angle cannot be assessed from your posted photos.
	
	I hope you realize that this format of posting questions and receiving answers lacks the face to face direct communication required for you to make an informed decision regarding your surgery.
	
	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.

Toby Mayer, MD · Answer

Rhinoplasty for the male upturned, short nose is done by extending the length of the nose with grafts of both cartilage and skin. This is similar to the procedure that we do for revisions that essentially have a short nose like yours. You can see photos of this procedure on our website. Make sure you see an experienced revision rhinoplasty surgeon since this is not a beginner procedure.

William Portuese, MD · Answer

It is possible to correct an upturned nose with several different maneuvers. Trimming the inferior most portion of the columella to decrease the columellar show and a portion of the nasal spine will drop the projection and the nasolabial angle. A small wafer of cartilage at the nasal frontal angle may also help derotate the tip. It would be impossible to give more projection to this nose as in attempting to do so, it would rotate the nose higher than it already is. The average cost of a rhinoplasty is approximately $7000, which includes the operating room, anesthesia, and the surgeon’s fee for performing the procedure.

Robert Kotler, MD, FACS · Answer

Dear MrMonkey;

	Your analysis is correct.  The nasolabial angle is quite obtuse and rather unusual for a man.  Right now you can see right into the nasal cavities.  Apparently you did not have previous surgery, so yours is particularly rare. 

	Narrowing the tip of the nose runs the risk of the healing process making the nose tip up even more, so your case has to be dealt with very carefully.  You will probably require some cartilage grafts to help lengthen the nose at the same surgical session as the narrowing of the tip.  Regarding your desire for more projection, I am not sure I would agree with that.  In your case, nostril reduction, if you mean by that nostril narrowing, probably is not necessary.  The most important thing is that the tip of the nose be brought down and that you have a more masculine and, therefore, less obtuse nose-lip angle. 

	Yes indeed, this does call for a very experienced surgeon, whether it be in Europe, the U. S. or Canada.  I suggest you do the homework and you will then make a better decision.  Frankly, if you are not comfortable with the possibility at this appointment, then perhaps you might not want to do the surgery. 

	Good luck and best wishes.

	Robert Kotler, MD, FACS
	Facial Plastic Surgeon
	Author, SECRETS OF A BEVERLY HILLS COSMETIC SURGEON
	Author, THE ESSENTIAL COSMETIC SURGERY COMPANION

Michael L. Schwartz, MD · Answer

You do have a very rotated nose with obtuse nasolabial angle and significant nostril show which is not pleasing. Rhinoplasty with tip derotation and reset of the angle with extension grafts and or internal composite grafts will significantly improve your aesthetic balance. Better photos would also help determine if chin implant and or mild radix augmentation would help as well. This is not a routine case and you need to find an experienced rhinoplasty surgeon. Good luck!

Can an Upturned Nose Be Corrected?

Answers (10)