I want to reduce the size of my nostrils and modify the tip of my nose. What treatment would you recommend? (photo)
Doctor Answers 9
I know you say you don't need a bridge bone. But if you were a patient of mine I would try help you understand that all of the parts of the nose work together to create an overall appearance. The mere act of adding a little to your bridge will make the tip look smaller, even without touching the tip. Nonetheless, you do need attention paid to your tip.
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Asian tip refinement usually requires augmentation grafting
Due to the thick skin of the most Asian patients, reduction techniques are limited in effectively narrowing the shape of the tip. In most cases, some degree of increased projection in needed to push forward into the skin envelope and create narrowing (think of a pyramid that becomes taller and therefore narrower). These concepts are described in the video link below.
Refining the nose during Asian rhinoplasty
Though you mentioned you don't need your bridge addressed, the balance between your bridge, tip and nostrils is critically important in creating an attractive nose. With Asian skin, often the thickness of the skin requires increasing the projection of the tip of the nose, in addition to reshaping the cartilage, to increase its definition and size. Simply removing cartilage is not enough. Often when the tip is projected, the bridge may also need to be augmented slightly to maintain the balance.
Consult with an experienced Asian rhinoplasty specialist and look carefully at his/her Before/Afters to find a surgeon with the aesthetic that matches yours.
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Bulbous Tip In Asian Rhinoplasty
There are several techniques used to reduce tip bulbosity in Ethnic patients. Reshaping the tip cartilages, defatting the tip and putting in cartilage grafts. The techniques are described in the video links below.
thank you for the photographs
first off you want to get a number of in-person consultations with surgeons who clearly operate on the Asian nose frequently. If you feel like your bridge does not need augmentation that's fine. What may appear to be prominent nasal tip cartilage may be mostly soft tissue as the Asian nose typically has week small cartilage in contrast to what appears to be strong anatomy beneath. The nasal base reduction I think is a great choice in your case. In general I would say you may need tip refinement either open or endonasal approach but definitely a conservative nasal base reduction would be helpful. These surgeries can actually be performed under local anesthesia after you have been numbed with injectable anesthetics.
I'll attach some information that may be helpful
Chase Lay, MD
double board certified facial plastic surgeon
Asian facial plastic specialist
Reshaping Nose Tip and Nostrils (Asian Ethnicity)?
The tip can be reshaped with a closed rhinoplasty approach, and the nostrils can be reduced with an alar base reduction. Find a plastic surgeon with ELITE credentials who performs hundreds of rhinoplasties and rhinoplasty revisions each year. Then look at the plastic surgeon's website before and after photo galleries to get a sense of who can deliver the results.
Kenneth Hughes, MD Los Angeles, CA
Asian rhinoplasty would involve suturing the tip cartilages together to make the tip more narrow and a cartilage graft to give more projection to the tip, however thick skin will be an impediment to seeing a large refinement. An alar plasty involves small wedges of skin that are removed the basal nostrils to narrow the nostril base. This can all be done closed rhinoplasty techniques as an outpatient procedure under general anesthesia.
Tip and alar work
It is possible to narrow the nostrils and adjust the tip if that is what you desire. It is best to be seen in person to be properly evaluated.
Ethnic Rhinoplasty How to Attain a Beautiful Result and Avoid Horrible Complications!
The first thing that you must realize is that 90% of surgeons are going to recommend placing a silicone implant. This is a quick and dirty solution that can work with acceptable results for a limited period of time under thick skin that most Asian ethicities have. DO NOT LET SOMEONE DO THIS. The long term aesthetic results are poor and the lifetime complication risk is unacceptable in my opinion( doctors trying to sell an implant based procedure will tell you otherwise).
The right way to treat your nose is with a well thoughtout and planned rhinoplasty involving sculpting of cartilage harvested from one of your ribs. This may sound like a big deal but it is really routine in rhinoplasties requiring significant structural support. Any plastic surgeon with craniofacial training and experience treating ethnic noses will certainly have a similar opinion. The problem is that most surgeons performing rhinoplasty have limited training and limited number of "tricks" to get the job done.
A profile would be most helpful in giving you exact advise but you will need a dorsal unlay graft to give you projection and definition of your dorsal nasal lines, A septal extension graft to lower your columella and give your tip support and a tip defining graft combined with intracriural fat excision for refining your tip. I like to build this construct together so that they are mutually reinforcing.
Your entire procedure should be done through a CLOSED technique, do not let someone talk you into open rhinoplasty as the outcome is less likely to be stable with an open technique.
Find a surgeon comfortable with open technique and using lamellar rib cartilage grafts in ethnic noses.
I hope this helps!
All the best,
Rian A. Maercks M.D.