Rhinoplasty is an operation that has undergone an evolution over the last decade. Patients and surgeons have an increased awareness of natural results. There is also an emphasis on providing stability for long term results, ones that will last 10, 20, 30+ years without developing problems. This is different from traditional surgeries, which used maximal reduction and resection as the means to achieve their results. The consequence of these techniques was an unnatural look with a high risk for long term partial nasal collapse and breathing difficulties.
The situation you describe is quite optimal for a natural-looking result.
- Most of the problems that patients encounter in both healing and operated appearance arise when aggressive tip surgery or overreduction of the profile is performed.
- If you like your tip and it can balance well with a reduced profile, then your likelihood of a natural result is increased.
- Additional benefit can be gained by leaving the bridge of the nose high.
- In some instances, a subtle hint of a bump may be cosmetically pleasing, depending on your overall facial structure.
- At most, a straight (not scooped) profile should be made, which runs just slightly (1-2mm) below your tip defining point, or highest point of the tip when viewed on profile. This optimal transition is medically referred to as a supratip break.
When patients require more extensive tip correction, I believe that several things are critical to ensure a 'natural' result.
I perform almost exlusively closed rhinoplasty, which by definition limits the number of grafts and sutures that can be used to modify the tip. As a consequence, I approach a nose with the mindset of how it can be modified, based on the underlying structure. My goal is not to restructure the nose using multiple grafts, but to remodel the existing cartilages into a different form.
With this in mind, my computer imaging consultation is driven by the concept of remodeling. Other surgeons will image what they want and then figure out how to get there. This often leads to an increase in the number of grafts that are used. Grafts increase a patient's potential for long term complications and may become visible over time as healing progresses. I limit their use to an absolute minimum and typically only require them for deviated nasal corrections or patients seeking a more 'stylized' result.
Translation: Remove only what you must, change only what is required, and ensure that structures will be stable over a long period of time. I believe that retaining and working with the essence of a patient's nose, not striving for radical wholesale change, is what provides a natural result.
