I come from a mixed backrgound (North Indian + Persian) and am contemplating rhinoplasty. Would you recommend tip grafts or sutures? If not supported well, will my nose become weaker over time? What about post-surgical scar tissue? I know it's difficult to answer w/o a feel of my but what techniques would you perform? Are there any recommendations for rhinoplasty experts in the Greater Toronto Area who have operated on substantial ethnic noses?
Is Reduction Rhinoplasty with Tip Enhancement Worth It? (photo)
Doctor Answers 9
A conservative Rhinoplasty will bring your facial beauty to another level as far as the natural features of your face are preserved.
Without physical examination it is hard to give you a solid opinion and the exact planning but the nose should not become "weaker" as you age. Naturally, with or without surgery the nose will undergo changes.
I recommend that you seek consultation with a board certified surgeon of ample experience who will assess you and guide you to make a well informed decision.
Best of luck to you and thank you for sharing your photos.
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Your posted photos show a dorsal hump, slight beak quality to the tip, possible oblique deviation of the septum to the left (hard to tell because your head is tilted in the photo) and a boxy or squared tip. The standard approach to that is removal of the hump, septoplasty to straighten the septum (if needed), adjustment of the nasal bones to close the roof after hump removal, trimming the upper edge of the tip cartilages and suture shaping of the tip. The use of grafts to the tip would depend on how thick the skin is and how much tip definition (how much of a Romanesque appearance) you want. That is best approached at the time of your face to face consultation with a prospective surgeon.
I hope you realize that this format of posting questions and receiving answers lacks the face to face direct communication required for you to make an informed decision regarding your surgery.
My response to your question/post does not represent formal medical advice or constitute a doctor patient relationship. You need to consult with i.e. personally see a board certified plastic surgeon in order to receive a formal evaluation and develop a doctor patient relationship.
Techniques to increase tip projection and definition.
From the photos you provided I would recommend increasing the tip projection slightly while reducing the dorsal projection to provide a more balanced profile. The tip shape can be modified with a combination of conservative excision along the superior border of the lower lateral cartilages (cephalic strip resection) in combination with domal suture techniques plus a projecting columellar strut cartilage graft. Cartilage tip grafts can be added if there is still inadequate tip projection. In the vast majority of cases a combination of suture and cartilage grafting techniques are used. If your skin is overly thick I would recommend careful sub-dermal thinning.
Mario J. Imola, MD, DDS, FRCSC.
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Ethnic Rhinoplasty Changes
Almost all open rhinoplasty uses some combination of cartilage grafts and suture techniques to obtain the desired tip reshaping. It is rare that just one method is used exclusively. The combination produces the best tip stability over time. There are many variations within these techniques and which is best for you is absolutely impossible to predict beforehand. Computer imaging would be important to determine if your goals is what the plastic surgeon thinks is possible.
An evaluation in person is critical to provide you with an accurate surgical plan to achieve your goals. But remember, you have very thick skin which may limit the ability to adequately see the same definition in the tip as a thin skinned person.
Question about rhinoplasty
It is good that you have done some background search and you are asking the right questions. You need to see a board certified plastic surgeon with interest in rhinoplasty. See before and after results and the surgeon will tell you exactly what you need. You have the right approach to your surgery.
Ethnic rhinoplasty must be performed by a surgeon well versed in this type of surgery. The thick nasal skin, bulbous tip and wide nasal base need attention as well as deviated nasal pyramid and weak chin. Cartilage grafts are definitely needed both for stability and refinement. Look at as many before and after pictures before to determine who can do a better job with your type of nose. Good luck
Grafts vs sutures depends on how much definition you are looking to achieve
Based on your pictures and our experience we would recommend an open procedure so that the surgeon can really look at your tip and see what can be achieved with suture techniques first and if that is not achieving sufficient tip defintion and projection then you may need a tip graft. My partner Dr Litner is from Toronto but he does not know anyone who has particular experience with "ethnic" rhinoplasty.
In our experience we would avoid trying to make your nose too small as that is when Persian patients tend to have problems with scar formation. The key is to find someone with experience who you feel comfortable with and can trust.
All the best,
Peyman Solieman, MD
Here in Beverly Hills we see many Persian noses with ethnic characteristics that require attention. Cartilages can be soft and weak; therefore they frequently need support using cartilage grafts. For example they are used to maintain tip position and projection. You want to decrease the width of your tip, improve definition, and narrow the nasal base. You should reduce the moderate hump of bone and cartilage. Consider a small chin implant. Best of Luck.