Can Nasal Tip Rotation Make An Overreduced Lip Lift Look Less So?

Q: Dr. Eppley, During our initial video chat I had mentioned that the second lip lift had also caused further descent of my nasal sill resulting in increased nostril show from the front. I consulted some other surgeons in LA about it around the same time, and like you, they all said that nothing could be done to raise the sill back up but I was told by two of them about another way to potentially address the problem. From looking at my side profile (attached for you to see), they both said my nasal tip seems to be rotated upward quite a lot and that I could afford to rotate the tip down with a septal extension graft, and that could correct or at least significantly improve the problem.

I’ve seen some before and afters and it definitely seems worthwhile. I was interested to know what you thought as well.

A: While it is true that you can’t raise the nasal sill back up, it may be able to be partially camouflaged by tip rotation. Doing some computer imaging from the side profile it should be able to be demonstrated whether that is a valid aesthetic effect/concept. On paper it would seem to be but ‘seeing’ is believing from the patfient’s perspective.

When it comes to downward nasal tip rotation there are the two ways to do so. An internal septal extension graft is one option which provides a push of he tip cartilages downward from behind. The other approach is infralobular onlay grafting (using septum) to build out he tip cartilages and push the skin down. Having used both I have found either approach can work. The choice would depend on how much tip rotation is needed to create the desired effect. I will have to do some computer imaging and would need a side view picture of your nose to do so.

Dr. Barry Eppley

Indianapolis, Indiana