It's a gorgeous piece of work, heavy metal and expertly finished. In order to get the escutcheon plate exactly flush to the wall, you will need to cut and thread a pipe nipple for your exact wall and tile thickness. It will be a complete stroke of luck if a stock nipple will work. The nipple needs to extend out from the wall surface exactly 9/16". Here's how to do it. Get a nipple that is definitely too long. Install it in to the wall. Measure and mark it precisely, to extend exactly 9/16" from the wall surface. Remove it from the wall and cut it to exact length. Now get a coupler and another LONG nipple or piece of threaded pipe and couple your custom cut piece to it. Take it to Home Depot and they can thread the cut end for you. Undoubtedly your custom cut nipple will be too short to fit in the gigantic threading machine. That's why you couple a longer piece of pipe to it, that's what will fit in to and be held by the thread cutting machine. There's no charge but I palmed the guy $20.00 for it, which is WAY cheaper than calling a plumber out to the house to custom cut and thread a nipple. You will need two good pipe wrenches to uncouple this rig after it's threaded. Don't try Vise Grips or Channelocks, they won't work! The threading process really screws the two pipes and the coupler TIGHTLY together. Now, to screw the nipple in to the wall you need an internal pipe wrench, since you won't have any unthreaded exposed pipe to grab on to screw it in. Like this, or any other brand:https://www.amazon.com/Superior-Tools-2-Inch-Internal-Wrench/dp/B000AO1IOI/ref=sr_1_1?ie=UTF8&qid=1521401132&sr=8-1&keywords=internal+pipe+wrench+1%2F2It's a small PIA to get it done but worth it to have your beautiful expensive Kohler elbow precisely installed flush to the wall. Or, just use a nipple that's too long, and have your elbow sticking out in the air looking like hell!