Do you think alarplasty & tip plasty would work for me? (Photos)

Question

I have been thinking about rhinoplasty for long, but recovery time and general anesthesia are deal breakers for me.. The thing that bothers me about my nose most is the bulbous tip, and wide uneven nostrils. I do recognize that my nose has sharp side profile and hump, but i feel like that doesn’t bother me that much. I just want a more feminine nose. Do you think alarplasty + tip plasty would work for me? I do recognize that full rhinoplasty would be best, but i think i’m not brave enough.

Matthew Bridges, MD, FACS · Answer

I'm not sure how the term "tip-plasty" came to be, but it's all rhinoplasty at the end of the day. Why are the recovery process and general anesthesia "deal breakers" for you?   You should go have a discussion about the process with a rhinoplasty expert.   I perform all rhinoplasties, whether the tip is modified or not, via the closed approach.  This approach dramatically reduces the recovery time.  Don't get hung up on semantics.  I don't understand what you think the difference between "tip-plasty (or "alar-plasty" for that matter) and rhinoplasty is...

Donald B. Yoo, MD, FACS · Answer

Hi amanda28847

Based on your photos and aesthetic goals, you are a good candidate for alar plasty and rhinoplasty with tip work. Referring to it as "tip plasty" is a matter of semantics, but the fact is reshaping the tip properly will require a rhinoplasty consisting of only tip work, if that is what you desire. The bridge and dorsum can be addressed independently, and left alone if you wish, but the bridge and tip will also heal simultaneously, so it does not prolong the recovery to reshape it as well. Careful discussion of the risks, benefits and alternatives during a comprehensive with an experienced rhinoplasty specialist will give you a more clear understanding of what I'm clumsily trying to explain over a few sentences.

Eric M. Joseph, MD · Answer

Based on your photos, you appear to have a wide nasal tip appearance, a droopy nasal tip, and an overprojected nasal profile appearance. I suspect that if you do not have work done to the bridge of your nose, you might regret it post-surgically. Please consider meeting with a reputable rhinoplasty specialist who offers computer Imaging so you could see what my what to expect after surgery. I hope this helps!

Steven M. Denenberg, MD · Answer

Yes, from the photos you posted, especially the frontal, it appears that the cartilages that form the tip of your nose are wide and broad, and modifying those cartilages would narrow your tip. You didn't post a 3/4 view, but when the tip is prominent, the 3/4 view often makes the nose look longer, and narrowing the tip can make the nose in that view not appear as long. The woman in the before and after I posted with this answer had that kind of a nose.

General anesthesia is not necessary for a rhinoplasty. We use IV sedation, no gas, no breathing tube, and it works fine.

Let's talk about not being brave enough for a "full rhinoplasty." You mean also working on the hump and perhaps the length, rather than just the tip, right? First of all, working on the entire nose is *not* a more extensive procedure than just working on the tip. Even if we were to leave a bump alone, for example, I still need to get underneath the skin in the area of the bump in order to work on the tip and make sure the skin drapes attractively at the end of surgery. After working on the entire nose rather than just the tip, you would feel exactly the same with your splint on after surgery, and your recovery time -- loss of swelling, etc. -- would be identical. In fact, technically, changing the tip is over 90% of the work of the operation in a nose like yours. Re-shaping the tip cartilages is the hardest part.

Then, when you work on one part of the nose, it's important to make sure that all the parts still fit together. If we narrow your tip and leave the bump there, or if the nose could be elevated a bit but we don't (I can't quite tell from the profile view) then with the reduced prominence of the tip, a bump is likely to look more prominent after surgery than it was before, or the length of the nose might be more noticeable, and those unaltered features could bother you more.

So, having said all that, there *are* some patients who really just want the rest of the nose left alone, and yes that's possible to do, but don't go there because you worry the operation would be bigger or more extensive. That's just not a thing! Do it only if you truly love the other features and don't want them changed at all.

How *much* to narrow the tip, or lower a bump, or make other changes? We figure that out with morphs, well before surgery. I'd love for you to see some excellent professionally-designed morphs of what could possibly be done with your nose. Morphs could also help you identify better just what's bothering you, and help you set a goal for the rhinoplasty that's accurate for your tastes. Profile and three-quarter views would be particularly important in morphing your nose. (Side note: in my opinion, morphs should really be done by the surgeon, or he should direct an assistant as she makes the morphs. Morphs should be made with a constant eye to what actually *can* be done in surgery, for that particular nose, and the surgeon has that information and judgment best.)

Finally, 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 that your nose needs require advanced techniques, and skill that most plastic surgeons don't possess with expertise. 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. And it also discusses how to take photos that are best for online evaluations.

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