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Will Rhinoplasty Slim my Overall Bulbous Nose Without Altering the Tip?

I have a very round and bulbous nose tip with a flat bridge. There's almost a "breakage" point as seen in the second photo. I'd like to implant a nose bridge in hopes of straightening my nose and slimming the overall appearance. I don't want alarplasty; is that possible without altering the tip?

Doctor Answers (11)

Will Rhinoplasty Slim my Overall Bulbous Nose Without Altering the Tip?

+1
Yes, you can have an implant to focus on the bridge.  You would benefit from thinning the tip of your nose to make it a smaller tip more inline with the structure of your face.


Beverly Hills Facial Plastic Surgeon
4.5 out of 5 stars 12 reviews

Rhinoplasty

+1

You do not have the do the alarplasty if you do not want one.  The dorsal augmentation and tip contouring will make your overall nose appear smaller.  Good luck.  Donald R. Nunn MD  Atlanta Plastic Surgeon.

Donald Nunn, MD
Atlanta Plastic Surgeon
5.0 out of 5 stars 5 reviews

Rhinoplasty for dorsal augmentation

+1

  The  bulbous tip can be addressed or left alone depending on the patient's desires. To augment the bridge, either a Silastic implant or patient's own cartilage will be required to build up the bridge line. To narrow the nasal bones, osteotomies are sometimes required. An alar-plasty is only performed when there are wide nostrils that are out of balance.

William Portuese, MD
Seattle Facial Plastic Surgeon
5.0 out of 5 stars 60 reviews

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Asian rhinoplasty

+1

possible plan - would have to see you in person (austin is close to dallas)

open rihinoplasty

carefully thin skin of tip

onlay rib cartilage graft to dorsum with perichondrial or deep temporal facial sheet on top to smooth contours. length designed such as to help lengthen overall length dimension of nose (i personally would not use and implant)

columellar strut (likely septal cartilage) to maintain tip support and help balance alar-columellar relationship.

 

I know you don't want the tip changed - and if that remains true the dorsal onlay graft would have to be of modest projection at best - it would still "slim" the nose

 

if you did choose to alter the tip the following steps could be added

 

tip shaping suture and likely tip grafts (septal and/or rib cartilage) with pericondrial or deep temporal fascia for smoothing of contours

 

 

Adam Bryce Weinfeld, MD
San Angelo Plastic Surgeon
5.0 out of 5 stars 35 reviews

Asian rhinoplasty

+1

Yours is a case of a typical #asianrhinoplasty. The breakage point you refer to is the step off between the tip cartilages and the septal cartilage part of the bridge. You can augment the bridge without doing tip work if you wish but I don't think just putting in a graft or implant will sufficiently narrow your bridge. You will likely also need an infracture to move the nasal bones towards the midline.

Before you go through the surgery you should have a thorough discussion with your surgeon including computer imaging of the different options available for your tip. You don't have to have the tip work but you should be fully aware of what the tip work has to offer before you decide against it.

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 in order to know if this assessment is valid.

Aaron Stone, MD
Los Angeles Plastic Surgeon

Rhinoplasty and dorsal augmentation

+1

You can certainly have dorsal augmentation. This is best done with rib cartilage rather than a synthetic implant. As for the tip to give it more projection you probably need a columella strut.

Steven Wallach, MD
Manhattan Plastic Surgeon
4.5 out of 5 stars 18 reviews

Ethnic Rhinoplasty issues

+1

You bring up several common issues for ethnic rhinoplasty. A flat bridge can be augmented with a variety of implants, an "L" shaped strut is the most popular and is a reasonable choice when there is thick skin as is probably your case. Thick skin limits tip refinement, but an experienced ethnic rhinoplasty surgeon will be able to improve the bulbous tip using permanent sutures to narrow the cartilage while giving it stronger structure. Alarplasty is optional but may be indicated for the best aesthetic result, if your nostrils look too wide after your tip is narrowed. The scars are usually well hidden. It is also possible to perform later if desired.

Edmund Fisher, MD
Bakersfield Facial Plastic Surgeon
5.0 out of 5 stars 11 reviews

Asian rhinoplasty techniques often use implants!

+1

Hello qtm21,

Thanks for your question.  It is indeed possible to add dorsal height to your nose without altering the tip.  The most common ways to do this are as follows: silicone dorsal implant, Medpor dorsal implant, cartilage graft (most commonly rib cartilage), cranial bone graft (less common), diced cartilage-fascia (DCF) grafts.  Each method has it's pros and cons.  You should seek consultation with an expert in Asian rhinoplasty to discuss your options.  In my practice, the most common method is to use a silicone dorsal implant made by Implantech.  Another method that is gaining popularity is the DCF graft dorsal augmentation.

I hope this helps!

Dr. Shah

Manish H. Shah, MD, FACS
Denver Plastic Surgeon
5.0 out of 5 stars 21 reviews

Nasal implant

+1

It is certainly possible to raise the bridge without altering your tip shape.  This would best be illustrated by having computer imaging performed by your surgeon to show you the anticipated changes.  Sometimes the tip should be raised or lowered depending on the height of the bridge but this doesn't appear to be likely in your case.  The next question is what material to use to raise your bridge--cartilage from your nose, ear, or rib?  A synthetic implant?  There are positives and negatives to each and this should be discussed thoroughly with your surgeon.

Colin Pero, MD
Dallas Facial Plastic Surgeon
5.0 out of 5 stars 8 reviews

Nasal Implants and Ethnic Rhinoplasty

+1

Hi,

Yes it is possible to elevate your bridge without altering your tip or alae. Make sure the implant you receive does not pass the supra-tip area of your bridge.

Best,

Dr.S.

Oleh Slupchynskyj, MD, FACS
New York Facial Plastic Surgeon
5.0 out of 5 stars 217 reviews

These answers are for educational purposes and should not be relied upon as a substitute for medical advice you may receive from your physician. If you have a medical emergency, please call 911. These answers do not constitute or initiate a patient/doctor relationship.