No refinement of tip according to first opinion. What do you think? (photos)

Doctor said that to refine tip and make nostrils smaller, it would take outside stitches and that when he fixed my over projection and the tip isn't so upturned, it will make the nostrils look less obvious. Does this seem correct? Also, any suggestions on the approach? Thanks!

Doctor Answers 7

Tip refinement needed?

Hello forty can kiss it!

Thank you for a great question and photos.  Based on the photos, your nose appears to have an overdeveloped nasal septum causing the overprotection of your tip and creating the shortening of your lower lip and appearance of a hanging columella.  However, you also appear to have some width to the nasal tip, which should also be addressed to optimize your result.  An open versus closed approach often depends on surgeon preference and the patient's anatomy.  The columella incision of an open rhinoplasty heals well and is rarely an issue as far as visibility.  In my experience, for anatomy such as yours, an open approach provides greater exposure and better accuracy.  I would recommend seeing a facial plastic specialist to address your concerns.  I hope this helps!

All my best!  Dr. Elizabeth

"This answer has been solicited without seeing this patient and cannot be held as true medical advice, but only opinion.  Seek in person treatment with a trained medical professional for appropriate care."

Nasal tip refinement

I agree that your nose is over projected and long. But you are also correct in that you have some excessive tip width as well as a hanging columella or base of the nose. Your lobule or part just below the tip also appears to hang on the profile view as well as you have poor distance or an acute angle between your upper lip and base of the nose on smile views. Finally, the vertex or up the nose view shows rounding to the tip region as opposed to a more normal pyramidal shape to the tip. I would recommend you consider doing the entire nose and include the tip in the rhinoplasty or it will leave you a suboptimal result. Whether an open approach or a closed approach is employed, this is usually a choice between you and your surgeon. Personally, it depends upon my examination of the nose, whether previous surgery has been done before, and patient wishes that determines whether or not I use a closed or open approach to the tip area. Good luck in your area.

Scott Trimas, MD
Jacksonville Facial Plastic Surgeon
5.0 out of 5 stars 18 reviews

Rhinoplasty , some advices:

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.

Dr. Emmanuel Mallol Cotes.-

Emmanuel Mallol Cotes, MD
Dominican Republic Plastic Surgeon
4.7 out of 5 stars 149 reviews


As part of the procedure I would recommend reduction of the tip projection by reducing the cartilage of the septum as well as reducing the size of the paired tip cartilages.  An open approach would allow this to be performed with greater exposure and more accuracy.  Best wishes, Dr. T


It is difficult to say exactly how your nose looks because in all of the photos you are smiling.  However, your tip shape is very good on profile and has a bit of a boxy shape from the bottom.  

You could benefit from tip contouring - this involves gently repositioning and folding the cartilages to create a more defined tip and controlling the 3D shape of the position and rotation.  If you feel that your tip sticks out too far, this can be reduced a few millimeters, but that might cause your nostrils to flare, which is why the original surgeon mentioned the possibility of outside sutures along your nostrils to narrow them slightly.

Overall, it would be important to see your photos in neutral pose as well as smiling and discuss what your own goals are about your nose shape.  Additionally, he should be able to provide some simulation images so that you can make sure that you are on the same page regarding ideal nasal proportion and tip shape.

Good luck,

Christopher C. Chang, MD

Washington DC, Maryland, and Virginia


Hello and thank you for your question. Based on your photograph, you may benefit from a tip refining rhinoplasty. Your surgeon can accomplish this by trimming, suturing, and reshaping the cartilage in your lower nose. Cartilage grafts may also be used to help improve tip refinement. You may also benefit from a nasal tip deprojection to decrease the overall size of your nose and a conservative dorsal hump reduction.  Make sure you specifically look at before and after pictures of real patients who have had this surgery performed by your surgeon and not just a computer animation system. The most important aspect is to find a surgeon you are comfortable with. 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

Richard G. Reish, MD
New York Plastic Surgeon
5.0 out of 5 stars 67 reviews


Thank you for your question. In terms of approach, the open Rhinoplasty provides better access to the underlying structure of the face through incisions that are barely perceptible. Always consult with a board certified facial plastic surgeon.

Best wishes,

Ross A. Clevens, MD
Melbourne Facial Plastic Surgeon
4.7 out of 5 stars 93 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.