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Does Tip Refinement Result in a Tip Becoming More Elevated?

Hi, I have a boxy, bulbous tip that I would like refined to a more slim almond-shape. I currently like the elevation of my tip, and I'm satisfied with the amount of nostril show I have from the front view, but I'm wondering if tip refinement will result in my tip being pulled up more..which is something I don't want. For what it's worth, I am of Middle Eastern descent and have thick skin. Thank you!

Doctor Answers 17

Tip Refinement in Middle Eastern Nose Does NOT Need to Elevate Tip

You ask a very important question. It is critical especially in Middle Eastern patients to not over-rotate the tip while refining it. I have written on this topic in numerous textbook chapters and articles on Middle Eastern Rhinoplasty because it is so important to not erase ones ethnicity. Producing too much tip rotation is a problem I see a lot in noses that I have to revise.  The tip can be shaped and refined without tip rotation however, you should discuss thoroughly with your surgeon on whether tip repositioning of any sort may benefit your overall nasal harmony.  Please do your research very completely and closely look at before after pictures and meet with several surgeons.  You do NOT want to go to someone who does not show you a lot of pictures of a variety of nasal types and ethnicities and who hides the front view. The front view is the most telling view that reveals the skill of your surgeon because simply removing a hump on the bridge is quite easy compared to subtle tip refining in a customized manner.  The links below may help. Good luck.


Beverly Hills Plastic Surgeon
4.0 out of 5 stars 73 reviews

Refining tip without changing tip elevation

An experienced surgeon can perform rhinoplasty is such a way that the tip can be refined witout changing your nostril show or tip rotation. Not everyone does it in this way, however, so you need to be clear about your wishes.

Look at before and after photographs of similar patients to make sure you like the results.

Thomas A. Lamperti, MD
Seattle Facial Plastic Surgeon
5.0 out of 5 stars 15 reviews

Rhinoplasty Tip Refinement

Hi Nosee (I like your name)!

The most effective and accurate way to treat the boxy/bulbous tip is through non-destructive suture technique which is almost always performed through an open rhinoplasty incision.  Tip position is completely controlled by cartilage graft reinforcement to allow for tip elevation (rotation), tip de-rotation, or neutral position.

Your thick skin may have a negative effect on tip refinement in general.  A detailed in-person examination by a qualified surgeon will give you an idea of how your result might look.  Additionaly, photographic morphing can be performed to help communication between you and the doctor, which will ultimately increase the likelyhood of your satisfaction with the surgical outcome.

Best of luck!

Gerald Minniti, MD, FACS
Beverly Hills Plastic Surgeon
5.0 out of 5 stars 43 reviews

Nasal Tip Refinement Without Rotation

The answer is yes, you can improve tip definition without rotation.  This may be best done through and endonasal approach.  That means there's no external scar/incision and the cartilages are viewed, trimmed, and sutured by the surgeon with less tissue dissection.  When you have more dissection or and open rhinoplasty you can have some rotation early that will settle, so just be aware.

Regarding you skin thickness.  If the goal is a more defined tip the changes made by the surgeon may take time to show themselves due to your skin thickness.  Be patient.  Some surgeons may be inclinded to be more aggressive with cartilage removal or with defining sutures with your skin type which can be just fine but just be aware that it takes longer to see your results and it may one day (even years from now) look too sharp and defined.  I reference a revision I did on a woman's nose after she had really aggressive cartilage resection 15 years ago.  So if the surgeon is somewhat more concervative and  the tip doesn't look awesome to you in the first 2 to 4 weeks, just be patient, it will change.   Rhinoplasty success, truely, is measured in months or years, not in weeks.

Another thing, in the immediate post op period your nose may appear a little rotated just from swelling.  Don't be concerned, it will relax.

Best of luck.

Dr. Chase Lay

Chase Lay, MD
Bay Area Facial Plastic Surgeon
5.0 out of 5 stars 49 reviews

Tip Refinement

The optimal way to tip refinement is to do an open approach using multiple suture techniques and, if needed, a lip graft may be indicated in patients with 1. thick skin, 2. male, or 3. in Ethnic rhinoplasty patients. This helps to re-shape and elevate the nasal tip for finesse tip refinement.

Rod J. Rohrich, MD
Dallas Plastic Surgeon
5.0 out of 5 stars 27 reviews

Nose tip refinement

Upper tip rotation usually does not occur at the time of primary rhinoplasty when narrowing the nasal tip.  In a few select patients there can be a very slight (1-2 mm) elevation that is very miniscule.  Refinement of the tip has to be performed by either removal of tip cartilage, sewing the tip cartilages together, or a combination of both.  The thick skin can be an ongoing postoperative issue which most likely will necessitate several cortisone shots in the postoperative period to the supertip area of the nose to prevent the tip from becoming more swollen.  

William Portuese, MD
Seattle Facial Plastic Surgeon
5.0 out of 5 stars 66 reviews

Does Tip Refinement Result in a Tip Becoming More Elevated?

Thank you for your question. Tip refinement is a general term. Per your preferences, rhinoplasty can improve tip shape without necessarily elevating the tip. Communicate your preferences clearly to your surgeon. Your skin thickness, ethnicity, and desire to preserve certain nasal characteristics can and should be factored in when your surgeon develops a surgical plan. Good luck.

James M. Pearson, MD
Los Angeles Facial Plastic Surgeon
5.0 out of 5 stars 50 reviews

Tip refinement in the Middle Eastern nose

It is possible to refine the tip without causing greater upward rotation (or "pulling up") of the tip. Tip refinement is a term that can include many different techniques. Commonly performed steps to address a boxy tip include cephalic trim of the lower lateral cartilages, and various suture techniques to alter the shape of the tip. Tip rotation, tip projection, the relationship of the tip to the dorsum, and nasolabial angle are also important factors in what makes a nose attractive, and each of these can be altered as needed. Thick skin at the tip is common in patients of Middle Eastern descent, and this can make it harder to appreciate the underlying structure or small changes in the tip. The best thing you can do is tell your surgeon what you like about your nose and what you dislike about it, and be very clear about your goals. Good luck!

Anita Patel, MD
Beverly Hills Plastic Surgeon
4.5 out of 5 stars 12 reviews

Nasal tip refinement and tip position

Nasal tip size, shape, and position tend to be related variables, but also may be independently controlled during rhinoplasty. Be sure your surgeon understands your desired result, and agrees that he or she expects to accomplish at least a close approximation.

Steve Laverson, MD
San Diego Plastic Surgeon
5.0 out of 5 stars 40 reviews

Tip refinement without tip elevation

Your question raises two important issues.  The first issue is whether you can modify a boxy tip without upwardly rotating the tip.  Many of the steps uses in tip refinement during rhinoplasty often times can lead to slight to significant upward rotation of the nasal tip.  Awareness of the fact that you like the current position of your tip will enable your surgeon to perform tip refinement without tip elevation.  The second point that you bring up is that you have relatively thick skin.  Your thick skin likely contributes to the appearance of your boxy tip.  I would spend some time with your rhinoplasty surgeon discussing realistic expectations with regards to what you can expect as a final result given the relative thickness of your nasal skin and how much refinement you can expect.

Philip S. Schoenfeld, MD
Chevy Chase Facial Plastic Surgeon
4.5 out of 5 stars 12 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.