Tip Deprojecting and Reshaping Through a Closed Rhinoplasty?

Can you deproject the tip through a closed rhinoplasty? Also, is it possible to reshape lower allar cartilage through this approach? For instance if their shape is pointing down, like a hook, can you reshape it so it points upwards? I already had my tip rotated upwards a little (slightly above 90 degrees), but because of the shape of the cartilage and its length, it still looks droopy. I prefer having a closed surgery because I don't want any visible scar, however minor, if I can avoid it.

Doctor Answers (10)

Tip Deprojection and Reshaping

+3

Without good before and after photographs, it is difficult to give you specific advice related to your nose. That being said, the tip can be deprojected using different techniques via the endonasal (closed) approach. In the endonasal approach, a transfixion incision will allow for some deprojection.  If the lower lateral cartilages are too long they can be shortened and this will deproject and can rotate the tip ( change if from a pointing down to pointing up).  I recommend you seek consultation with a Board Certified Plastic Surgeon.


Newport Beach Plastic Surgeon
4.5 out of 5 stars 9 reviews

Reshaping Tip With Closed Rhinoplasty

+2

Hello,

It is possible to perform these procedures with a closed rhinoplasty, but it will take a little more time. With an open rhinoplasty, the scar from the incision will be almost invisible. Thank you, and I hope this helps.

Dr. Nassif

Paul S. Nassif, MD
Beverly Hills Facial Plastic Surgeon
5.0 out of 5 stars 32 reviews

Tip Rhinoplasty With Closed Approach

+2

The answer is - yes. A closed rhinoplasty approach can be used to deproject the nasal tip as well as to reshape the lower lateral cartilages. A rhinoplasty specialist should be able to evaluate your nose and give you advice on what the best approach would really be in order to achieve the most optimal outcome. Good luck.

John M. Hilinski, MD
San Diego Facial Plastic Surgeon
5.0 out of 5 stars 18 reviews

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Tip shaping through closed rhinoplasty is a reality

+2

Rhinoplasty as a open technique is still new on the scene compared to the closed approach. Closed rhinoplasty had been successful for decades in rotating and derotating the tip, changing tip shape and projection, and adding visible tip grafts. For some surgeons, open techniques are 'easier' and more options are available in controlling and altering shape, and as the debate rages on for most, the scar has not been an issue. You should be able to find a surgeon skilled in closed rhinoplasty if your look carefully.

Best of luck,

peterejohnsonmd

Peter E. Johnson, MD
Chicago Plastic Surgeon
4.0 out of 5 stars 28 reviews

Closed vs Open

+2

Most older, well trained plastic surgeons can do what you ask via a closed approach. I do 95% of my surgeries closed, open is reserved for the most difficult tips and some revisions.

William B. Rosenblatt, MD
New York Plastic Surgeon
4.0 out of 5 stars 9 reviews

Tip Changes with Closed Rhinoplasty

+1

Your tip can be revised with a closed rhinoplasty. Do not be concerned about the scar if your surgeon recommends using the open technique.

Richard W. Fleming, MD
Beverly Hills Facial Plastic Surgeon
5.0 out of 5 stars 14 reviews

Closed Rhinoplasty works well for tip reshaping!

+1

Although my personal preference for secondary tip work is via the open rhinoplasty approach, a skillful practitioner of the art of closed rhinoplasty can certainly reshape your tip very nicely. The final outcomoe may not be quite as good as with the open approach, but it allows you to avoid the columellar scar which is a priority for you.

George Sanders, MD
Los Angeles Plastic Surgeon
5.0 out of 5 stars 3 reviews

Revision rhinoplasty using an open approach would be used in my practice to achieve tip rotation and deprojection.

+1

I read your concern. Many rhinoplasty surgeons are able to achieve desired results using a closed approach for rhinoplasty surgery, but this has not been my experience.

All of my patients that require nasal-tip work are operated on using an open-approach for Rhinoplasty. In my practice, the columella scar has not been problematic for my patients.

In many cases, a droopy overprojected tip would be repaired by dividing your lower lateral cartilages, suturing your medial crurae together, deprojecting the medial-crural-complex, placing a columella-strut, and performing a cephalic trim of your lower lateral cartilages. In my view, all of these delicate maneuvers are facilitated through an open-approach.

I hope this is helpful for you.

Eric M. Joseph, MD
West Orange Facial Plastic Surgeon
5.0 out of 5 stars 276 reviews

Reshaping and deprojecting the nose.

+1
Yes this can be done closed. I have used the openapproach for 35 years but still do noses closed as well. You may not have as much control as you would with an open approach. The scar should not be seen and I have never had to revise one.

Toby Mayer, MD
Beverly Hills Facial Plastic Surgeon
5.0 out of 5 stars 14 reviews

Closed rhinoplasty and tip derotation

+1

I think it is more precise to perform tip and derotation work using an open approach.  A closed approach is liking working on a car engine with the hood down.

Steven Wallach, MD
Manhattan Plastic Surgeon
4.5 out of 5 stars 17 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.