Bulbous nose tip refinement

Thank you for your question. You have obviously done some excellent research.  An educated patient is an great patient, as it is our goal as plastic surgeons to give our patients all the information possible to help them make the right decision. Tip plasty (or tip refinement) can be done through the closed technique, depending on the skill of the surgeon and the anatomy of the patient. Some plastic surgeons will do telephone consultations if you are having trouble finding someone in your area. Finding the right surgeon is an important decision, as your rhinoplasty results will be with you for the rest of your life. I suggest looking for a board certified plastic surgeon who specializes in rhinoplasty and has years of experience. 

First of all the "before" photos that are your first two posted photos are of a patient of mine, and yes, your nose has many similarities to her. See the video example for her "after" photos.Also, see the "Web reference" link, just below my response. I made a computer morph, and an animation of the morph, showing what changes your nose could have in truly expert hands, narrowing that tip. And yes again, it is possible to work on only the tip, if that is the only part of the nose that bothers you.You should understand that the changes I demonstrated in the morph require advanced techniques, techniques that most plastic surgeons cannot handle. Be sure to read the section in the "Web reference" link on how to stay out of trouble while searching for a rhinoplasty surgeon. In particular, you need to see photos of noses like yours. Carving a hump off of a profile is a different operation than handling a wide tip!

Thank you very much for sharing your concerns with us.The harmony between facial parts makes us instinctively recognize the beauty... without knowing it, without defining it, just a perception that surprises and captivates us.In this regard, I suggest perform a Closed Rhinoplasty (without visible scars) to treat the tip, base and nasal bridge.With this procedure you get a delicate nose, better harmonize with your other facial features.Respectfully,Dr. Emmanuel Mallol Cotes.-

Hi P,Your lower lateral nasal cartilages are large.  They can be refined through an endonasal approach, I would prefer a delivery technique.  Once this is accomplished, hopefully the rest of your nose is in harmony with your tip.  If not, then some very conservative maneuvers can be done to give you a great natural looking nose.  The cost of rhinoplasty varies depending on the surgeon.   It is mouch more expensive to correct a poorly performed rhinoplasty.  Choose your rhinoplasty surgeon most carefully.  Good luck and be well.Dr. P

Hello phirey0ne,Thanks for your question.Your bulbous tip is due to malposition of your lower lateral cartilages.  In other words they are in the wrong position giving them a taller appearance.An open tip rhinoplasty, in my opinion, is the more appropriate operation for you to safely and strategically reposition your tip cartilages while refining your tip elements.This is a procedure I perform routinely in the office using local anesthesia and oral sedation.  The patients tolerate the process well and are universally satisfied with the cosmetic outcome in my hands.An in-office tip rhinoplasty starts at around $3500.If you'd like more information, please contact us at my office in Cherry Creek.Have a nice day,Dr. Shah

Hello and thank you for your question. Based on your photographs, it is possible to perform a tip narrowing and refining rhinoplasty. Your surgeon can accomplish this by trimming, suturing, and reshaping the cartilage in your lower nose. Cartilage grafts can also be performed to improve the tip refinement.  The most important aspect is to find a surgeon you are comfortable with. With good surgical technique, you could have an outstanding result. I recommend that you seek consultation with a qualified board-certified plastic surgeon who can evaluate you in person.Best wishes and good luck.Richard G. Reish, M.D.Harvard-trained plastic surgeon

You are certainly a good candidate for a nasal tip refinement. From your picture, it is evident that you have very prominent lower lateral cartilages and very thin skin. The tip of your nose is also hanging down and your nasolabial angle seems to be less than 90 degrees. Although a closed approach is possible, it can often lead to noticeable asymmetry. I would recommend using an open approach to achieve the most correction. Do your research, as this is a procedure you only want to have done once.    

Great photos from great angles, thanks!You are unfortunately not a candidate for an endonasal procedure.  The great news is that the scars from the external approach are really quite subtle and not an issue in my 15 year experience. However, your nose is actually quite complicated.  There are several key features for tip support that will need to be constructed to insure you have a stable nose that doesn't collapse after surgery.You are a great candidate!Dr. Hobgood

 A full rhinoplasty is usually required to make sure all of the nose cartilages and bones balance with the new nasal tip. Most patients must undergo a full rhinoplasty. The bulbous tip is reduced by suture techniques and a  conservative cartilage removal. A closed rhinoplasty approach can address all the desired changes. For more information, diagrams, and many examples, please see the link and the video below

Improving the a bulbous
tip to achieve an improved natural appearing cosmetic result is a frequent
request of patients wanting nasal refinement. It is possible to improve the
cosmetic appearance of the tip alone without altering the rest of the nose in
some patients. Whether the optimal option in your particular situation would be
a tip rhinoplasty alone or a full rhinoplasty would best be determined at a
consultation. Either procedure can be performed with a closed or open approach.
Following the advice from a surgeon on this or
any other website who proposes to tell you exactly what to do based on limited
2 dimensional photos without examining you, physically feeling the tissue,
assessing your desired outcome, taking a full medical history, and discussing
the pros and cons of the operative procedure would not be in your best
interest. I would suggest you find a plastic surgeon with extensive nasal
surgery experience who is certified by the American Board of Plastic Surgery
and ideally a member of the American Society for Aesthetic Plastic Surgery
(ASAPS) or a facial plastic surgeon (ENT) that you trust and are comfortable
with. You should discuss your concerns with that surgeon in person.
Robert Singer, MD FACS
La Jolla,California