The nasal tip can be straight, upturned or downturned. The shape of the nasal tip goes a long way in defining the personality of the nose. The length, refinement, and position of the nasal tip and its form defines the aesthetic character of the nose.  The nasal tip gets its support from the alar cartilages and their shape, size and position will determine the appearance of the tip.

Nasal tip rotation means that the nasal tip will be turned upward or downward depending on the patient’s requirement and the surgeon’s evaluation. Nasal tip rotation is analysed by measuring the nasolabial angle. This angle is measured by drawing a straight line through the most anterior and posterior points of the nostrils and a perpendicular line to the horizontal facial plane.

For Nasal tip rhinoplasty the first step is for the patient to be mentally and physically ready. So if you are thinking of tip rhinoplasty, make sure that you understand the implications and other contradictions associated with the same.  The tip rotation depends on many factors such as the ethnic background of the patient, their height and gender. Generally, upward rotated tip is associated as a feminine feature.

The need of nasal tip rotation arises because the cartilages get weak as we get older or because of previous rhinoplasty surgery and it causes the tip to tilt downward. Therefore, the angle between the tip of the nose and lips changes and the nose tends to appear longer in the side profile.

Analysis for nasal tip rotation

Before the nasal tip rotation Rhinoplasty the surgeon will do a careful analysis of the face. This analysis will include the frontal view, the side view, the caudal view and the assessment of skin and the tip support.  This will help the surgeon determine the amount of rotation needed and what kind of approach that can be used for the same.  Various tip support mechanisms are also evaluated. These include size, shape and resilience of the medial cartilages, nasal spine, attachment of the cartilages to the skin, septal dorsum and the septum.

Approaches to nasal tip rotation

Tip rotation Rhinoplasty is performed after careful evaluation. There is no perfect tip angle defined but there is a perfect tip angle for every face and nasal tip rotation is done accordingly. There are mainly two methods used in nasal tip rotation rhinoplasty one is the suspension suture technique and the lateral crural steal. In both the methods the nasal tip is measured beforehand intraoperatively, after the creation and after checking the performance. This ensures that there are no problems later on.

In the suspension suture technique

In this technique, a graft and sutures are used to rotate the tip to the desired position. This is a very simple and effective technique. In simple words the nasal tip is opened from inside and the graft is placed inside. Three sutures are used in a triangular fashion to give support to the tip. The tip rotation is then assessed before closing the flaps. Once the surgeon is satisfied with the work the flaps are then closed and bandages are placed on the tip to help it heal better.

Lateral Crural Steal

This is another popular method which can work both on tip rotation and tip projection. In this method the lateral crura is shaped to obtain the desired results. Various techniques like sutures and cartilage removal is used to change the shape of the lateral crural from convex to flat giving the nasal tip the rotation that is desired.  This technique not only gives a good definition to the nasal tip but also adds to the strength of the nasal tip and external nasal valve/.

Nasal tip rotation is combined with tip projection, to balance the symmetry of the nose. The recovery period is fairly simple and short and all you need to take care is to protect your nose from trauma and follow the surgeon’s post-operative care instructions to the letter.


About Dr. Debraj Shome

Dr. Debraj Shome- Facial Plastic Surgeon in Mumbai, India

Dr. Debraj Shome – Founder, The Esthetic Clinics, is a top facial plastic surgeon. Dr. Shome is currently a Consultant at the best Mumbai hospitals like Saifee Hospital, Breach Candy Hospital, Nanavati Hospital & Apollo Spectra Hospital in Mumbai, India. He has 40+ research papers in the best international journals, numerous presentations at conferences & many awards such as “Best Plastic Surgeon in Mumbai”, “Best Plastic Surgeon in India”, Best Cosmetic Surgeon in India”, “Best Cosmetic Surgeon in Mumbai”, “Breakthrough Innovator in Facial Plastic Surgery” etc. A celebrity plastic surgeon, Dr. Shome believes plastic, reconstructive & cosmetic face surgery can allow you to lead a more fulfilled life….Read more

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