Tip Rhinoplasty: The Nose Knows

Rhinoplasty is surgery to change the shape of the nose.  The nose has many subunits, one of which is the nasal tip.  This area is a critical part of the nose and gives it much character.  Reasons to perform a "tip rhinoplasty" are to change the shape of the nasal tip.  Common complaints are to change a nasal tip that is wide, boxy, bulbous, or narrow.

Other procedures may be performed at the time a nasal tip is addressed during rhinoplasty.  Such procedures include addressing the width, height, and length of the nose.  Procedures can also be performed to improve breathing (e.g., septoplasty, turbinate reduction, spreader grafts). 

It is important to select a surgeon who is properly licensed, trained, and experienced in performing this type of procedure.  Clearly communicate your goals to your surgeon so he/she can meet and hopefully exceed your expectations.

A tip rhinoplasty involves changing the relationship of the lower lateral (alar cartilages) with the upper lateral cartilages and the caudal septum to refine the tip of the nose. It can be as simple as a "cephalic trim" or trim of the upper part of the bulbous tip cartilage, or more involved with adjustment of the septum at its base and grafts placed between the nasal ala to enhance and rotate the tip.

Best bet is to consult with either a board certified plastic surgeon or otolaryngologist who does a large volume of rhinoplasties (or "nose jobs") so that you have adequate information before entering into surgery.

Be careful, as changing one aspect of the nose (i.e. the tip) can change the whole balance of the nose (i.e. the bridge or dorsum, etc), so you never want to go with someone who is offering you the shortcut or easy way to do a rhinoplasty, as it is inherently a complicated procedure that varies from individual to individual depending upon their nasal anatomy.

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When a surgeon plans a Rhinoplasty, 3 basic parts of the nose are always considered. The nose is typically broken up into 1/3rds.

1. The upper third is the nasal bones, which can be responsible for a wide nasal bridge and is usually a component of a nasal hump.
2. The middle third is the cartilaginous vault, where the nasal septum and cartilage canopy exist. This area is typically also involved in a bump, but, more importantly, has a critical role in nasal deviation and nasal obstruction.
3. Finally, the lower third, or nasal tip, is the lowest and most mobile portion of the nose. Drooping of the tip, excess volume or width of the tip, and nostril asymmetry are the most common problems seen in this region.

A tip rhinoplasty is, therefore, any operation that seeks to change the volume, angle, or height of the nasal tip. Alterations can range from simple to complex, depending on the degree and scope of an individual patient's problem. A wide variety of outcomes are typically possible, depending on both the patient's desires and the surgeon's aesthetic sense.

It is critical that this region balances with the rest of the nose and the overally structure of a patient's face and body. The nasal tip is the area where, if this balance is not achieved, an "operated" appearance may result.

Various types of techniques, including suture modification, cartilage excision, or structural grafting may be used to achieve the desired aesthetic outcome.

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A tip rhinoplasty usually refers to treating the tip of the nose.  Therefore, no work is performed on the septum or the dorsum( i.e Hump or depressed bridge).  Usually this is for patients that want a more refined tip because the tip is too bulbous or round.

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Tip rhinoplasty refers to the anatomic part of the nose that is affected during surgery. The nose can be divided to upper 2/3 (the dorsum), and the lower 1/3 (the tip). During rhinoplasty one or both parts of the nose can be altered to change the shape of the nose.

Most surgeons would agree that the tip area is the most challenging part of the nose to treat. During nasal tip surgery, various procedures can be performed to alter the size, the projection, or the rotation. In the US, most patients request the nasal tip be made smaller, more defined, and narrower. During revision rhinoplasty, nasal tip asymmetries may need to be addressed. Trimming of the nasal tip cartilages, suture narrowing of the cartilages, and cartilage grafts are some of the techniques that are employed in affecting a change to the shape of the nasal tip.

There are two general approaches for tip surgery: the closed approach and the open approach. In the closed approach all incisions are within the nose. In the open approach there is an incision in the mid columella (the strut in the base of the nose) as well as intra nasal incisions.

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