It is common for patients to have 1 or 2 things that really bother them about their nose. One of the most common concerns that prompt patients to seek rhinoplasty is the shape of the nasal tip. In many instances there are other aspects of the nose that could be improved simultaneously during rhinoplasty; some common problems include a dorsal hump (bump on the bridge), crookedness, and poor nasal airflow. However, often times these problems are imperceptible to the patient presenting for rhinoplasty as they are focused on their major concern. Following surgery, these other problems may be more apparent to the patient once the major concern has been addressed. Additionally, reducing or reshaping the nasal tip alone can cause a change in the relative proportions of the nose leading to an unbalanced look. In some patients, the tip is the only major issue and rhinoplasty focusing on the nasal tip alone can improve the overall nasal appearance. In many cases, there are other things that if not simultaneously improved, may be a source of dissatisfaction following rhinoplasty.
Some common concerns with the tip include its shape, size, and position. Problems with shape may include asymmetrical, bulbous (round), or boxy shapes. The nose may be too large or too small. The position of the tip may be too projected or have inadequate projection or may be over- or underrotated. During surgery of the nasal tip, these should all be taken into consideration to achieve the best result.
In your case, it appears that you have fullness of the dorsum especially in the supratip area (area just above the tip). Reduction of the dorsum in addition to tip shaping would help create a better overall result and improve your profile making it more balanced and congruent with your face.
Your hump will not look worse if you limit the surgery to improvement of your tip. However, consider reducing the hump at the same time. A good consultation will include a discussion of all your alternatives.
Although it is understandable-- it is wishful thinking to expect limited tip reduction to significantly improve your nose. In my opinion, to get your best looking nose- you would require the application and effective utilization of standard rhinoplasty techniques.
1) tip reduction
2) bony narrowing
3) significant profile reduction and tip elevation
Make sure to go to an Board Certified Plastic Surgeon who specializes in nose surgeries, and look at his/her Before and After pictures.
Hope this helps
Your nasal tip can be refined with some internal sutures which reshape the cartilage. This would not make your bridge bump appear larger, in fact from the side view, a small reduction in your bridge bump at the same time as your refinement of the nasal tip would give an improved balance to your nose. This wouldn't change the appearance of your nose, just refine it.
I would recommend tip refinement as well as upward rotation. Mild rasping of the dorsum can also help with the final result. Be very detailed with your surgeon regarding what result you expect from your surgery.
The tip can be refined without changing the other aspects. This may not be exactly what you want. You should have a discussion with a plastic surgeon about what would be best for you.
Kenneth Hughes, MD
Los Angeles, CA
When performing only a tip plasty, the remainder of the nose must be in excellent balance. Performing a tip plasty only will make the tip out of balance with the remainder of the nasal components. Dorsal reduction, hump removal, and osteotomies will all be required.