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Small Nose but Wide Flat Tip Rhinoplasty Options? (photo)

I have small features, and a small nose; small nostrils, and the bridge is straight. But the tip is wide and flat and from straight on, my nose looks like a "U." I could balance a coin on the tip of my nose even! :) I have not seen another nose like mine, but wondering what options I might have to refine the tip, thin it out some, and maybe shorten it a tad and give it some shape. I am very open to suggestions, and seriously considering surgery with the right doc. Opinions and comments welcome!

Doctor Answers 10

Your Rhinoplasty Need Not Be as Complicated as You Think

Greetings, Jana.

The anatomy of your nose is not that uncommon. Have operated on many with the same imperfect cartilage structure.

The main activity is refining the tip cartilage and making it hormonious with the upper portion of your nose which is pretty satisfactory. Not as complicated a case as you might think.

Your situation is one where the entire nose does not need to be operated, just the lower half. That  is a good scenario: less swelling and bruising which translates to faster recovery. d

Pleased to be of advice to our friends in Tucson, a great place to live.

-Robert Kotler, MD, FACS



Beverly Hills Facial Plastic Surgeon
5.0 out of 5 stars 72 reviews

436 N Bedford Drive
Beverly Hills, CA 90210

Rhinoplasty option for small wide flat tip nose

The flat nose tip is due to the more vertically shaped lower lateral cartilages that can be addressed removing a portion of the cephalic part.  Dome binding sutures then bring the tip cartilages together to refine, narrow, and give more definition to the nasal tip itself.  It is also important to make sure that the tip of the nose is balanced with the nasal bridge and any dorsal irregularities are addressed.  Osteotomies will narrow the midthird of the nose.  This can all be done through a closed rhinoplasty technique under general anesthesia.  

William Portuese, MD
Seattle Facial Plastic Surgeon
5.0 out of 5 stars 70 reviews

1101 Madison St
Seattle, WA 98104

Small Nose but Wide Flat Tip Rhinoplasty Options?

I have performed Rhinoplasty and Revision Rhinoplasty for over 20 years and from your photos, IMHO, this is a very difficult Rhinoplasty case for the following reasons:

  1. The nasal tip is wide and boxy with very prominent tip cartilages.
  2. The skin, of the nose is quite thick as seen on the base view.
  3. The mid and upper sections, of the nose are aslso wide.
  4. The base, of the cilumella has a slight hanging component that would need to be tucked.

IMHO, to address all of these issue making the entire nose (not just the tip) smaller and more shapely would require an Open Rhinoplasty with resection of the tip crtilages as well as osteotomies to thin the nasal bones.

Francis R. Palmer, III, MD
Beverly Hills Facial Plastic Surgeon
4.5 out of 5 stars 12 reviews

8500 Wilshire Blvd
Beverly Hills, CA 90211

Rhinoplasty Techniques for the Wide, Flat Tip

The wide, flat tip you have is not rare but it is challenging to change the contour of your cartilages. Simple removal of the excess will not solve the problem. Usually it is necessary to reorient the cartilages and  place small grafts to  support the nose and improve nostril shape  while improving and maintaining breathing function and making your tip proportional to the the upper part of your nose. The experience of your surgeon is critical.

Richard W. Fleming, MD
Beverly Hills Facial Plastic Surgeon
5.0 out of 5 stars 22 reviews

416 N Bedford Dr
Beverly Hills, CA 90210

Suggestions to improve my nose

In the approach to rhinoplasty, your presenting anatomy is important, the specific features you wish to change and how you wish to change them, your internal examination, skin thickness, previous injury and/or surgery, and detailed external examination, including feeling the nasal bones and cartilages.  Although your pictures are helpful, they are all at angles that don't conform to professional photographic standards for plastic surgery.

Even in 2011, with broadband and the capability to communicate in real time with many highly qualified plastic surgeons from around the world, your best option to understand what can realistically be accomplished for you is personal consultation.

Steve Laverson, MD
San Diego Plastic Surgeon
5.0 out of 5 stars 41 reviews

477 North El Camino Real
Encinitas, CA 92024

What can be done for my nose?

These concerns are common for patients just beginning to explore the rhinoplasty option. Your tip cartilages are flat, boxy and cephalically oriented. This can be markedly improved with a combination of conservative resection,  and aggressive tip shaping and reorientation with suture techniques. Good luck.

Michael L. Schwartz, MD
West Palm Beach Facial Plastic Surgeon
5.0 out of 5 stars 8 reviews

1515 North Flagler Dr.
West Palm Beach, FL 33401

Small nose but wide flat tip rhinoplasty options

Jana B,

Your nose has the type of variation that we refer to as a parentheses deformity.  The lower lateral tip cartilage that should project lower and more laterally, sweep superiorly to give your nose that U shape you see...or the apparence of a parentheses.  This is a common issue that can be absolutely corrected to give your nose more definition and shape.  By reorienting the cartilage I would also be able to support your nostrils to give you a better airway and ability to breathe in the long term.  Meticulous rearrangement and refinement of your nose will create a lovely result as you already have structure that is close to ideal from a profile standpoint.  Primarily your surgery would be an artistic reshaping of the cartilage structure of your nose.  Hope that helps!  Dr. Shep

Shepherd G. Pryor, MD
Scottsdale Facial Plastic Surgeon
4.5 out of 5 stars 20 reviews

8952 E Desert Cove Ave
Scottsdale, AZ 85260

Rhinoplasty for the wide, flat tip.

Rhinoplasty for the wide, flat tip with a parentheses deformity is not for the young rhinoplasty surgeon. This requires a great deal of experience to reorient and contour your cartilages along with cartilage grafts for your middle nose, etc.

Toby Mayer, MD
Beverly Hills Facial Plastic Surgeon
5.0 out of 5 stars 24 reviews

416 N Bedford Dr
Beverly Hills, CA 90210

Rhinoplasty for a wide and flat tip

The width and shape of the tip can be determined by skin thickness, and by the shape and strength of the cartilages underneath. Rhinoplasty has the flexibility to address both, and your surgeon should be able to sort out necessary changes during your consultation.

Best of luck,

Peter E. Johnson, MD
Chicago Plastic Surgeon
4.0 out of 5 stars 36 reviews

8901 West Golf Road
Des Plaines, IL 60016


I sense tip-plasty in your future. Thinning your tip depends a lot on the thickness of the skin. Rotatng your tip superiorly will imorove you lip tip angle and hepl reoreint the lateral crus.

David A. Bray, Sr., MD
Los Angeles Facial Plastic Surgeon
4.5 out of 5 stars 6 reviews

3711 Lomita Blvd.
Torrance, CA 90505

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.