An upturned, over-rotated tip can also be an issue for patients following rhinoplasty. The “pig nose” look is one of the most common concerns that patients express prior to rhinoplasty surgery in which a droopy tip is lifted. Overrotation generally occurs because the septum is shaved back too aggressively. This also causes the nose to look shortened on profile view. The other possibility is over-shortening of the lateral crura, the portions of the tip cartilages which run just above the nostrils.
Lengthening the nose may require placement of a caudal septal extension graft. This is a cartilage graft comprised of either septal or rib cartilage which is stitched to the front of the septum with strong, permanent sutures. Spreader grafts, described in detail on the inverted-V deformity page, can also be helpful. In cases in which the tip is too upturned, the spreader grafts are fashioned to be longer than usual, to push the tip downward. These are called extended spreader grafts and can be as long as 2.5 cm or more in length.
If the tip is overrotated and projecting too far forward from the nose, the tip can be brought down and in with a technique called the medial crural overlay. In this maneuver, the portions of the lower lateral cartilages between the nostrils, the medial crura are shortened. This is achieved by cutting the cartilages, allowing them to overlap, and then stitching them back together.
In general, lengthening and counter-rotating a shortened and overrotated tip requires strong, long pieces of cartilage. In most cases, septal cartilage is insufficient and rib cartilage is often needed. Ear cartilage tends to be too weak to achieve these objectives.
Please contact us today to book a consultation if you suffer from an over-rotated tip.