Will adding a graft to the tip of nose project my nose more and if so will it look bad?

Question

Will adding a graft to the tip of nose project my nose more & if so will it look bad? I’m planning on getting a rhinoplasty soon and was already planning on shaving down the hump & rotating tip. But one of the surgeons I consulted with mentioned a graft at the tip of my nose in order to support it . Will my nose project too much and will it look wierd or bigger because of this?

Steven M. Denenberg, MD · Answer

You have that hump on the bridge that can be taken down, but you have thick-ish skin, and, from these photographs at least, tip cartilages that are not the thickest and strongest, and that means that it will take exceptional skill to elevate the tip to where it needs to be.
If your bump is taken down and the tip is not elevated substantially, your nose will look much worse. 
The issue of a tip graft isn't important. If you select your surgeon well, he'll use one if he feels it's necessary and not if he doesn't, and if he's very good he won't do anything bad to your projection. I see the tip elevation as the most technically-demanding part of the operation, and putting in a graft would not do anything toward elevating the tip.
Remember that rhinoplasty is an exquisitely difficult operation to get right, and you should only have surgery if you are able to make yourself very confident in your surgeon's skills. The changes I described above require advanced techniques, requiring skill that most plastic surgeons don't possess with expertise. For most noses, it's much better to not have surgery than to have inexpertly-performed surgery. Read my essay on how to stay out of trouble while selecting a rhinoplasty surgeon. 
Your nose is also a perfect example of why computer imaging is mandatory in rhinoplasty. You need to know exactly what the surgeon is planning to accomplish -- what features he thinks he can change, and by how much he thinks he can change them. I always email morphs to my online rhinoplasty consultations. When you see the surgeon's goals in the morphs, you'll know whether he has an eye for an attractive nose, and whether he shares your opinion of what constitutes an attractive nose. You'll also know whether the changes he proposes are large enough to be meaningful to you, and whether he understands your wishes enough to address all of your priorities. How would you ever get that figured out without the morphs?! 
But remember, you're not the surgeon for his skills with the computer. The doctor must then show you his before and after photos to prove that he can actually accomplish what he draws on the computer.

Suleyman Tas, MD, FEBOPRAS · Answer

Hello,More photos are needed for better evaluation, Each face has different proportion and facial features, your issues can be addressed to hump removal and tip evelation.Well proportioned, balanced look can be achieved with maximal healing and minimal tissue damage by Closed and Atraumatic Rhinoplasty.Best Regards,

Nima Shemirani, MD · Answer

Dear jaqvi,Adding a graft to the tip to give it support may or may not affect the projectionFor example, you can take down the hump, lift the tip, deproject it and then add a tip graft for better definitionI know it seems counter intuitive, but sometime you have more control of the look of the nose when you do it that wayFor thicker skin, I would also use a tip graft to control definition.  A morphed image should be done to reassure youBest regards,
  
Dr. Nima
  
Member, American Academy of Facial Plastic and Reconstructive Surgery
  
Board Certified Facial Plastic Surgeon
  
Board Certified in Head and Neck Surgery

Ronald J. Edelson, MD · Answer

the main thing you need is reduction of the hump.  The tip can also be refined either with or without cartilage grafting. Personally I’m not a fan of routine tip grafting but many surgeons are.  I think the tip graft is optional in your case.

Robert D. Wilcox, MD · Answer

Dear Jaqvl, It depends what the plastic surgeon intends to do with the tip graft.  He may actually mean an Anderson strut to keep the tip from retracting in, in which case it would not be visible on the tip.  On the other hand, the surgeon may feel to get more definition of the tip, he is going to need a small graft to get the proper shape.  If the surgeon has imaging modalities where he can morph your image on a computer screen, then you and your surgeon can be sure you are on the same page aesthetically.  Best of luck to you.
Robert D. Wilcox, M.D.

Roy A. David, MD · Answer

That is an excellent question. Rhinoplasty is performed in stages, beginning with hump reduction and usually osteotomies. At that point, the tip is assessed along with its relationship to the bridge. The tip should project slightly past the bridge and if the height is not sufficient, a tip graft may be necessary. This can usually be determined at your consultation with computer imaging, but sometimes the decision is made during surgery. Consult with a board certified facial plastic surgeon to examine your options.

Will adding a graft to the tip of nose project my nose more and if so will it look bad?

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