I find my tip very pointy and edgy because the allar cartilage is sticking out, is very pronounced and pointed a bit downwards at the end (the actual shape of cartlg.). What tecniques can be used to make it more rounded, or soft looking through a closed rhinoplasty? How can you reshape this kind of tip and make it more "baby" like?
Pointy Tip Cartilage - What Can I Do?
Doctor Answers 15
Thin pointy nose tip cartilage
In many instances this occurs in thin skinned individuals wtih prominent cartilage. Addition of fascia may be an option but may be difficult through a closed approach.
Reshaping the tip of the nose in Endonasal (closed) Rhinoplasty
Thank you for the question regarding the techniques for reshaping the tip of the nose. In my San Francisco Bay Area rhinoplasty practice, I perform both endonasal (closed) rhinoplasty as well as open rhinoplasty and the choice of which approach to use is based on the needs of the particular patient and the unique anatomy of that patient's nose.
From your description of your nose, it seems that you are bothered by the edges of your tip cartilages showing through the skin of the tip of the nose. This could be related to either the shape of your underlying tip cartilages or the thickness of your nasal skin. If it is a cartilage issue, the cartilages can be trimmed and reshaped using a delivery approach in closed rhinoplasty. In this approach small incisions are made inside the nostrils and the cartilages are "delivered" or brought forward to reshape them under direct vision. The cartilages are then returned to their original position. In patients with very thin skin, particularly in revision rhinoplasty but at times in primary cases, a fascia, or soft tissue graft can be placed over the tip cartilages to soften them. This fascia graft is harvested by making a tiny, inconspicuous incision behind the hairline in the temple.
As for the downward pointing tip, a graft such as a columellar strut can be placed to support and rotate your tip. Another option is a septocolumellar suture, which brings the tip up by securing it to the septum. Both of these techniques can be performed through a closed approach. The degree to which the tip sticks out from the face (tip projection) as well as the rotation (up/down position) of the tip can be controlled through these techniques.
The last point that I would make is that often an open rhinoplasty approach is most desirable for addressing the tip of the nose. The tiny incision across the columella heals beautifully if created and closed with care and attention to detail. The scar should be essentially undetectable as it heals. The tradeoff of this miniscule incision versus the access which the open approach provides the surgeon may be worth it, though again it depends on the individual patient.
Rhinoplasty for pointy tip
Making precise structural changes to the tip cartilages is one of the most complicated (and least forgiving) aspects of rhinoplasty. I'll start by saying that it is difficult to answer your question without a physical examination. But if I'm understanding you correctly, it sounds like you have a very firm alar cartilage. It also sounds like you may have thin skin (which makes the cartilage seem more prominent). This can be addressed in a number of ways, but if it is the lower part of the cartilage, then I would recommend not removing this part of the cartilage. The lower part of the alar cartilage plays a very important role in keeping the nostril down and maintaining tip shape. Sometimes you can also weaken the cartilage to reshape it, but the surgeon has to be very careful here to maintain tip stability, shape, and symmetry. I would highly recommend seeking a consultation if this bothers you. Good luck with your search!
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Nasal tip surgery
Dear rhinoplasty patient,
It is difficult to render a professional opinion without examining your nose or seeing a photo. If you truly need just tip work and there is no sufficient skin thickness, I would recommend an open rhinoplasty with non-destructive suturing technique and covering it with Alloderm or fascia. You must see a surgeon specializing in rhinoplasty. Good luck
"Pointy" Tip Cartilages
With thin nasal skin you can see every minor tip cartilage irregularity. Although very challenging, a beautiful shape and contour can be achieved. There are several techniques which frequently involve placement of cartilage or fascia grafts over the existing tip cartilages.
There are several techniques to perform rhinoplasty. The most important thing for you is to see a board-certified plastic surgeon in consultation and discuss the options. Without examining you or evaluating photos, it is impossible to give you specific advice. Good luck.
Accurate Diagnosis and Precision are required in addressing a Pointy Tip
Thanks for your question. Interestingly, I saw two "Pointy Tip" rhinoplasty consultations yesterday, but even though they shared similar tip appearances, the diagnosis was different.
One patient had a clear case of the lower cartilages (tip cartilages) being overly long and therefore causing buckling and kinking, which showed through thin skin. The other also had fairly thin skin, but had only one "pointy" side, and this cartilage appeared kinked at the tip, but otherwise normal in length.
Surgeons differ in their approach to the tip, (open or closed,) as you can see in the answers provided. Success in treatment relies both on an accurate diagnosis and on precision in executing the operative maneuvers.
My personal preference is to avoid "visible" cartilage grafts whenever possible, and, in my experience it is rare that I require such grafts in a non-operated nose. I have a preference for open rhinoplasty for addressing the tip, especially in cases where I need to shorten the tip cartilages.
Summarizing, a pointy tip has many causes. Accurate diagnosis is critical. Thin skin dictates very precise surgical maneuvers.
And now for the hard part... finding the right surgeon for the job. I have linked below to my RealSelf answer to the question "How to Choose a Good Rhinoplasty Surgeon?" where I discuss "10 qualities I believe a good rhinoplasty surgeon should have." Take a look.
Hope this helps.
Nick Slenkovich, MD, FACS
Pointy tip issues
If you are unhappy with the tip of your nose, I would recommend an open rhinoplasty to get precise treatment of the tip.
Pointy Tip Cartilage
Dr Mayer is right on "point"! Read his response a few times to understand this crush technique is not easy but will address all your tip issues. From MIAMI Dr. Darryl J. BLinski
Pointy Nasal Tip
It would be helpful to have multiple views of your nose to give you specific advice related to your “pointy tip”.
That being said, it sounds like you have very thin nasal skin which can reveal the edges of the underlying tip cartilage. Using the endonasal approach, crushed cartilage or temporal fascia can be used to "soften" a pointy tip.