Will I need a graft to achieve a more refined tip and aesthetically pleasing shape? (photo)

Based on your photo, you appear to have somewhat thick nasal skin and a bulbous tip appearance. He may utilize and extended shield graft in patients with relatively thick skin like yours to achieve maximum tip narrowing and to add structural support. That said, sometimes we put in tip grafts and they don't look good, as seen on the operating room table, and are removed before closure. In that regard, I believe you could achieve tip narrowing without a tip graft, however, sometimes they are very helpful for achieving a desired result. Thank you for this interesting question, and I hope it was helpful! Sincerely, Dr Joseph

Thank you for your photo. Additional photos would be helpful to evaluate your overall nasal tip width, tip projection, dorsal height, and other factors. It would also be helpful to know the thickness of your nasal tip tissues and the strength of your nasal tip cartilages as these are partially responsible for how much definition is achievable in your nasal tip. Judicious trimming of the nasal tip cartilages to remove sections which are too rounded or bulbous as well as nondestructive suturing of the nasal tip cartilages help to improve and refined the nasal tip shape and contour. Cartilage grafts from your septum to help support your nasal tip may be required, depending upon the strength of your nasal cartilages as well as the thickness of your nasal tissues. The best understanding of what would work best in your case and your expected results would be achieved after a face-to-face consultation with a board certified plastic surgeon as well as a detailed examination of your nose. Best wishes.

Unfortunately, you have not provided lateral views or inferior views. However, it looks like you have more than enough cartilage that a graft would not be necessary. I would need additional photographs to give you an accurate answer.

Best Wishes,

Gary Horndeski, M.D.