The Russian Nose is a popular aesthetic nose form in which the nasal tip is positioned upward at an angle above standard norms (high rotation), the nasal dorsum accompanies this upturn with a pronounced curve, and the tip has strong projection outward from the face. Rather than being a medical anatomical term, this design aims to give the face a younger, more dynamic, and “doll-like” expression, and is based on the principle of giving the nasal tip a sharp, diamond-like definition. Achieving this bold look requires more than a simple lifting procedure; it involves widening the nose-to-lip angle and ensuring long-term stability with special structural grafting techniques.
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What is Russian Nose aesthetics, and what are its key features?
When our patients come to the clinic, they usually have photos taken with certain filters or images of celebrities in their hands. The shared expectation of those who request a “Russian Nose” is the erasure of a tired and harsh expression on the face. The core philosophy of this aesthetic style is based on increasing the rotation of the nasal tip. In other words, the nasal tip rotates upward by widening the angle it makes with the lip. This makes the distance to the upper lip appear visually more open and airy.
However, this is not just a “lifting” procedure. The shape of the nasal tip also needs to change. Instead of a round, ball-like tip, a sharper, more angular tip structure is targeted—one where light breaks on the surface, with a diamond form or more faceted definition. The nasal dorsum, rather than descending straight, comes down from the mid-brow to the nasal tip with a sweet curve (like a slide). This curve further emphasizes the upturn of the nasal tip. In short, this style is a popular option for those who want to draw a confident, feminine, and bold profile.
The most distinctive visual features of this aesthetic style are as follows:
- High nasal tip rotation
- Pronounced nasal dorsum curve
- Short nose appearance
- Sharp nasal tip contours
- Narrow nostrils
- Pronounced nasal tip projection
What should the ideal nasal tip rotation angle be?
In rhinoplasty, the concept of “ideal” is actually based on a mathematical balance. The limit of how much we can lift a nose is defined by both aesthetic norms and the patient’s anatomy. The upturned look that comes to mind when we say “Russian Nose” requires operating near the upper end of these mathematical limits.
Under normal conditions, an angle between 95 and 105 degrees between the nasal tip and the lip is considered ideal in women. This range ensures the nose looks both natural and feminine. However, in the high-rotation Russian-style noses in question, our target is generally 105 degrees. In fact, if the patient’s facial structure, forehead width, and chin projection are suitable, this limit can be very slightly pushed to achieve a more “cool” look.
In men, the situation is completely different. An overly upturned nasal tip in a male face leads to a feminine expression and is generally undesired. The ideal angle for men is between 90 and 95 degrees. In other words, a flatter, more horizontal, and strong stance is targeted. The 105-degree “Russian” rotation targeted in women is a very sensitive working zone for the surgeon, because exceeding this angle uncontrollably can cause an unaesthetic appearance—commonly known as a “pig nose”—in which the inside of the nostrils is fully visible from the front. Therefore, high rotation does not mean an uncontrolled lifting procedure; on the contrary, it requires millimetric precision.
Why is nasal tip projection so important?
Two concepts most often confused in rhinoplasty surgeries are “rotation” and “projection.” Rotation is whether the nose points up or down, while projection is how far the nose extends forward from the face. In Russian Nose aesthetics, it is not enough to only rotate the nose upward; the nose must also extend forward strongly in the facial profile (projection).
You can think of this like a seesaw or a tent pole. If you lift the nose upward without supporting it forward, the nose may look “stuck on” and flat on the face. Especially when the nasal tip is lifted, the nose appears visually shorter. If projection (forward prominence) is insufficient, the nose disappears on the face and facial balance is disrupted.
In these bold noses, we need a very strong skeletal structure that will both keep the nasal tip elevated and push it forward. The distance between the point where the nasal alae meet the cheek and the nasal tip should be harmonious with the other proportions of the face. Correctly adjusting projection allows the nose to look “upturned but small,” while also enabling it to display a characterful stance.
What is the Structural Rhinoplasty method?
In the past, the method that came to mind when rhinoplasty was mentioned was “reduction,” meaning reduction surgery: remove the hump, cut the cartilage, reduce the nose, and close. However, this approach could cause long-term problems, especially in cases like the Russian Nose that require high upturn. Because the cartilages were weakened, the nasal tip would droop over time and breathing problems would begin.
Today, we adopt the philosophy of “Structural Rhinoplasty.” We can liken this approach to building construction. Just as you need to strengthen the columns and beams when restoring an old building, we also strengthen and reposition existing structures rather than cutting them away when reshaping the nose. We use cartilages taken from inside the nose (the septum) as building blocks. We shape these cartilages specially and place them as supports (grafts) at weak points of the nose. In this way, the nose can maintain its form even years after surgery. Structural rhinoplasty is not just reducing the nose; it is rebuilding it on a solid framework.
The main tissue sources used in structural rhinoplasty are as follows:
- Septal cartilage
- Ear cartilage
- Rib cartilage
- Temporal fascia
Which cartilage grafts (patches) are used?
To create a specific and bold shape like the Russian Nose, we need to go beyond standard techniques and place cartilage patches—called “grafts”—at strategic points. These grafts are architectural elements that allow the nose to preserve its new shape. Each graft has a different role, and they all work as parts of a whole.
The graft types we most frequently use in surgery are as follows:
- Columellar Strut Graft
- Septal Extension Graft
- Spreader Graft
- Rim Graft
- Dorsal Onlay Graft
- Tip Graft
- Alar Batten Graft
Each of these grafts is used to support or shape a different part of the nose. For example, separate grafts are used to prevent nasal alae collapse, and separate grafts are used to make the nasal tip appear sharper. However, in high-rotation noses, the leading roles are the Columellar Strut and Septal Extension grafts.
What does the Columellar Strut Graft do?
One of the main pillars that keeps the nasal tip upright is the “Columellar Strut Graft.” You can think of this graft as a hidden column that we place inside the skin and cartilage partition between the two nostrils, called the columella. We generally take a straight piece of cartilage from the patient’s own septum (the nasal mid-wall) and create support by suturing it between the medial crura, the cartilages beneath the nasal tip.
The main purpose of this graft is to provide vertical support to the nasal tip. Like the central pole of a tent, it prevents the nasal tip from collapsing downward. However, in very upturned noses like the Russian Nose, this graft alone may not be sufficient, because it keeps the nasal tip in place, but its power to rotate it aggressively upward is limited. Still, it is an indispensable component for building a solid foundation and ensuring nasal tip symmetry.
Why is the Septal Extension Graft critically important?
Here is the indispensable and most critical player of “Russian Nose” aesthetics: the Septal Extension Graft. If we want to lift a nose more than normal and “nail” it in that position, using this graft is almost mandatory. This technique is based on the principle of extending the septum and fixing the nasal tip to this extension by adding cartilage pieces to the existing nasal mid-wall (the septum).
You can think of this graft like a “cantilever beam” added to the main load-bearing wall of the nose. When we place this graft, we gain complete control over both the angle (rotation) and the forward prominence (projection) of the nasal tip. After bringing the nasal tip to the desired angle, we suture it to this graft. Thus, the nasal tip becomes resistant to gravity and to the pulling force of smiling muscles. This is the strongest technique to prevent the nasal tip from drooping over time. The main hero behind the characteristic, fixed, and upturned stance of the Russian Nose is usually this graft.
How does the tongue-in-groove technique affect permanence?
Another term frequently heard in the surgical world is the “Tongue-in-groove” technique. This is actually a term borrowed from carpentry and refers to two parts locking together by fitting into each other. In rhinoplasty, we use this technique to pass the nasal tip cartilages onto the end of the septum (or the septal extension graft) like a sandwich and suture them.
The biggest advantage of this method is stability. When the nasal tip cartilages (alar cartilages) are overlapped onto the septum and sutured, the nasal tip can no longer move independently; it behaves like a part of the septum. This prevents the nasal tip from being pulled downward, especially when smiling. In Russian Nose aesthetics, this fixation method is vital to ensure that the dynamic and upturned position of the nasal tip does not deteriorate even years later. In addition, this technique restricts excessive mobility of the nasal tip, providing a more “defined” and crisp stance.
How is definition (sharpness) given to the nasal tip?
An upturned nose will not create the desired elegant and attractive effect if the tip is round like a potato. Another hallmark of the Russian Nose is “definition,” meaning the contours of the nasal tip are distinct, sharp, and elegant. When light hits the nasal tip, there should be a clear highlight point rather than a scattered glare.
To achieve this, we use special suture methods called “suture techniques.” The cartilages that form the nasal tip (lower lateral cartilages) can be naturally convex. We narrow these cartilages by thinning them at a micro level and shaping them with special sutures.
The main suture techniques applied are as follows:
- Transdomal suture
- Interdomal suture
- Lateral crural suture
- Dome equalization suture
With these sutures, the highest points of the nasal tip cartilages (the domes) are brought closer together and refined. Thus, nasal tip width decreases and a more delicate, detailed appearance emerges. However, the surgeon’s experience is very important here; if the sutures are too tight, the nasal tip may look “pinched” or as if a “clip” has been applied. It is necessary to capture that fine line between naturalness and sharpness.
Do breathing problems occur from a functional standpoint?
A nose that looks great aesthetically is a failed nose if it cannot breathe. In Russian Nose aesthetics, when the nasal tip is lifted and narrowed, there is a risk that the airway inlet angle—called the “nasal valve”—may narrow. If this risk is not managed, the patient may feel unable to breathe after surgery even though the nose is open.
To prevent this problem, we use a “Spreader Graft.” You can think of these grafts as supports placed along both sides of the nasal dorsum that widen the roof. Like springs that keep a clamp’s mouth open, these grafts widen the narrowest part of the airway and facilitate airflow. They both refine the aesthetic lines of the nasal dorsum (dorsal aesthetic lines) and functionally guarantee the airway. In other words, when creating a high nose, we must also widen and support the internal air tunnels accordingly.
Does thick or thin skin affect the result?
One of the most important factors determining the result in rhinoplasty is the patient’s skin structure, as much as the surgeon’s skill. Because no matter how perfect a framework we build inside, what is seen from the outside is how the skin covers that framework.
Patients’ skin types are generally divided into the following categories:
- Thin skin
- Thick skin
- Excessively thick (oily) skin
- Normal skin
In thin-skinned patients, the biggest challenge is camouflage. The skin is so thin that even the slightest irregularity over the cartilage—an elevation the size of a pinhead—can be visible from the outside. In these patients, when creating a sharp-contoured nose like the Russian Nose, it is necessary to smooth the cartilage edges very well and sometimes place softening tissues (such as fascia) under the skin.
In thick-skinned patients, the situation is the opposite. The skin is like a thick quilt; it covers and hides the underlying details. It is much more difficult to reveal the fine, elegant, and upturned details of the Russian Nose in a thick-skinned patient. In this case, we must build the internal framework more prominent, sharper, and stronger than normal so that the skin stretches and reveals the underlying shape. Thick skin is also heavier and tends to pull the nasal tip downward. Therefore, in thick-skinned patients, we must apply the structural supports mentioned above (especially the Septal Extension Graft) much more strongly.
Can a Russian Nose be done in revision surgeries?
This style can also be applied in patients who have previously had nose surgery but whose nose has dropped or who did not achieve the desired shape. However, this is called “Revision Rhinoplasty,” and it is a much more complex process than the first surgery, because the septal cartilage, our valuable “spare part” inside the nose, is usually used up or damaged in the first surgery.
To create a form like the Russian Nose that requires high structural support, we need strong cartilages. If there is no cartilage left inside the nose, we need to transplant cartilage from another part of the body. At this point, “Rib Cartilage” comes into play. A small piece of cartilage taken from the patient’s own rib provides us with abundant and very solid building material.
The advantages of using rib cartilage are as follows:
- Provides abundant material.
- It is very durable and strong.
- It can be shaped smoothly.
- Its resorption risk is low.
Especially in order to bring a previously failed and drooped-tip nose into the “Russian Nose” form, rebuilding the nose almost from scratch with rib cartilage is the most reliable method.
What is the healing process and swelling management like?
After such detailed structural work, the healing process also requires some patience. In the first weeks after surgery, the nasal tip may look slightly more upturned than we planned. Patients may sometimes look in the mirror with the concern, “Is my nose too upturned?” However, this is a conscious choice by the surgeon, because during the healing process, with gravity and the weight of the skin, the nasal tip will settle downward slightly, even at a micron level (a settling allowance).
Swelling (edema) is the last thing to subside, especially at the nasal tip. While swelling on the nasal dorsum resolves more quickly, the nasal tip continues to shape itself slowly over the months. In surgeries like the Russian Nose where sharp contours are targeted, it is necessary to wait for swelling to completely subside for those fine details to emerge. While this process can take 1–2 years in thick-skinned patients, details become visible much earlier in thin-skinned patients.
Does nasal tip drooping occur in the long term?
The biggest fear of our patients is the question, “Will my nose drop?” In old-style surgeries performed with traditional methods, this risk was high. However, in the advanced structural rhinoplasty techniques we apply today, because we support the nasal tip not only with threads but with cartilage blocks, the risk of “drooping” has been minimized.
It is natural for the nose to gain some flexibility over the years with aging. However, a Russian Nose performed with the correct technique, using strong methods such as the Septal Extension Graft and tongue-in-groove, is highly successful in preserving its form and characteristic upturn. The key point here is the surgeon’s correct analysis and selecting the right technique appropriate to the patient’s tissue. As a result, with a well-planned surgery, it is possible to achieve satisfying results that defy time, both aesthetically and functionally.
Prof. Dr. Murat Songu – Burun Estetiği (Rinoplasti) Uzmanı
Prof. Dr. Murat Songu, 1976 yılında İzmir’de doğmuş, tıp eğitimini Ege Üniversitesi Tıp Fakültesi’nde tamamladıktan sonra Celal Bayar Üniversitesi Kulak Burun Boğaz Anabilim Dalı’nda uzmanlık eğitimini tamamlamıştır. 2005–2006 yıllarında Fransa’nın Bordeaux kentinde Prof. Vincent Darrouzet ve Dr. Guy Lacher gibi rinoloji alanının önde gelen cerrahlarıyla çalışarak rinoplasti, fonksiyonel burun cerrahisi ve kafa tabanı cerrahisi üzerine ileri eğitim almıştır.
Burun estetiğinde doğal görünüm, nefes fonksiyonunun korunması ve yüz estetiği dengesini ön planda tutan Prof. Dr. Songu, açık teknik rinoplasti, piezo (ultrasonik) rinoplasti, revizyon rinoplasti, burun ucu estetiği ve fonksiyonel septorinoplasti operasyonlarında ulusal ve uluslararası düzeyde tanınan bir cerrahtır. Yurt içi ve yurt dışında çok sayıda rinoplasti kongresinde eğitici ve konuşmacı olarak yer almış; yüz estetiği ve burun cerrahisinde modern tekniklerin yaygınlaşmasına öncülük etmiştir.
100’den fazla bilimsel yayını, kitap bölümü yazarlıkları ve 1700’ü aşkın uluslararası atfıyla rinoplasti alanında Türkiye’nin en saygın akademisyenlerinden biri olan Prof. Dr. Murat Songu, doğal, yüzle uyumlu ve fonksiyonel sonuçlar hedefleyen cerrahi yaklaşımıyla hem bilimsel hem estetik başarıları bir araya getirmektedir.
