Video transcript: So how do we perform a tip rotation manoeuvre in this patient? I decided the best technique for her was called a columellar setback and what that means is we take the central portion of the tip cartilages which are joined together and we tilt them backwards and reposition them onto the septum.
The big advantage of a columellar setback is that it doesn’t change the width or the shape of the nasal tip itself it’s moved in combination, so the two sides of the nasal tip and their relationships to each other don’t change because we have moved the entire tip together. So the way that looks on a diagram anyway is this portion of the nasal tip which is called the columellar, again it’s two sides of the tip both tips joined together in the middle is tilted in an upward direction after it is separated from the septum, tilted upwards and then repositioned on the septum and secured in its new position and it is done with a stitch that is present underneath the skin and is there lastingly so it holds on to that structure until it heals into position.
This is her views before and after and again you can see from the anatomy underneath the skin that the tip has been tilted in an upward direction from before to the after photo and I will just show you her actual results, so this is her before we reduced the hump and did a columellar setback to tilt her tip in an upward direction so that it comes away from the upper lip at a very nice angle, looks very elegant so I think she has had a good result from that from those two manoeuvres. This is her three quarter view again illustrating hump reduction and tip rotation and how that makes the nose overall look shorter and a little smaller I think for her just more refined.