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Objective: Precise electrode positioning is crucial for achieving optimal audiological outcomes in cochlear implantation. The slim modiolar electrode (SME), a thin, flexible, and precurved electrode, exhibits favorable modiolar proximity. However, tip fold-over can affect optimal electrode placement. Herein, we share our experiences with tip fold-over in SMEs and present an analysis of conditions that may predispose to tip fold-over., Study Design: Retrospective medical record review., Patients: In total, 475 patients (671 ears) underwent cochlear implantation using SMEs (Nucleus CI532 or CI632 from Cochlear) performed by a single surgeon at a tertiary center between June 14, 2018, and December 1, 2022., Interventions: Intraoperative x-ray scans (cochlear view), operative records, and cochlear duct length (CDL) were reviewed., Main Outcome Measures: Tip fold-over patterns on plain x-ray images (proximal versus distal)., Results: Electrode tip fold-over was observed in 18 (2.7%) of the 671 ears with SMEs. This fold-over occurred more frequently in cases with long CDL (>36 mm). Among the 14 cases with available initial x-rays before correction of the tip fold-over, half were classified as proximal and the other half as distal. A predilection for proximal tip fold-over was found in those with a CDL of 36 mm or longer, and longer CDLs were observed for proximal cases than for distal cases. Our pilot data suggest that identifying the type of tip fold-over can aid in correcting it more efficiently., Conclusions: Tip fold-over of SME does not occur uniformly and is more common in ears with long CDL. This tendency is particularly pronounced for the proximal type of tip fold-over. Therefore, preoperative measurement of the CDL and meticulous examination of intraoperative imaging are essential for customized correction., Competing Interests: The authors disclose no conflicts of interest., (Copyright © 2023, Otology & Neurotology, Inc.)