Overly Rotated Tip
Although the overly rotated tip is congenital in some people, all too often it is the consequence of the surgeon not recognizing that reducing the hump or bridge along with the standard procedure of trimming the upper edge of the wide tip cartilages results in loss of the support system that was keeping your nose from being too turned up. If the septum is shortened at its caudal [lowest] end the same thing can happen. Certainly this is not a primary concern if you have a droopy tip to begin with, but if you already have a borderline open angle between the upper lip and the columella and borderline too much nostril show…you end up with a Miss Piggy nose. Not a flattering term but your distress is palpable and you need to know there are specialists who have devoted themselves to this specific problem. I have over 25 years of experience de-rotating the tip and depending on the cartilage available and how much internal nasal mucosa can be stretched…at least a partial and perhaps an elegant lengthening of your short nose will happen. By the way…just to not be confusing…length is the vertical distance when standing from the upper point between the eyes where nose begins [separates from forehead] to the tip at its most projected aspect. Sometimes the tip will come down and the nostrils still flare and appear too arched and, therefore, a simultaneous borrowing from the ear [with typically not obvious scar] of a composite graft of skin adherent to cartilage must be placed inside the nostril rim to lower this area as well. As you can tell this is very sophisticated surgery and the doctors with experience and devotion to the nuances of this surgery are few and far between. I prefer to do this procedure closed and others do it through an open approach. I prefer not to scar the columella and since this columella is bearing the stress of the lengthening tension…I think it should not be cut. The most important thing is that you see results from the surgeon solving the exact problem and solving it will artistry.