An in person examination/consultation is usually required to make any decisions upon what needs to be performed on this nose. To narrow the bridge line, medial and lateral osteotomies are required. Tip suturing techniques are necessary to narrow the wide tip. An alar plasty is required to narrow the nostrils. When patient's have dark complected, thick oily, skin in the tip, frequent cortisone shots in the first few months after the procedure are required to prevent a poly-beak deformity.