Is it possible to remove only some cartilage from the nose with touching the bone? (Photo)

Question

My nose looks fat by looking at it and then i feel it and feel the bone underneath is way below and I don’t want my bone to be hammered into so is it possible to remove some cartilidge?

Richard G. Reish, MD, FACS · Answer

Hello and thank you for your question.  You appear to have thick nasal tip skin.  It is possible to work on the cartilage without performing osteotomies.   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.   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

Jason Altman, MD · Answer

Whether or not you need the bones of the nose altered depends on the changes you are looking for.  The nasal tip is composed of cartilage, while the upper portion of your nose is composed of bone.  If you are looking to only modify the tip, this can often be done with alteration of only the cartilage and no changes to the bone.  If you have a bump or the upper nose is too wide, then this will require adjustments of the bone as well.  It is best to discuss this with a rhinoplasty surgeon so that you can get a good idea of what is needed to achieve the look you want.

Tanveer Janjua, MD · Answer

Yes, the nasal tip can be changed with removing cartilage and there is no need for any bone removal.RegardsDr. J

Gregory Lakin, MD · Answer

Good morning, thank you for your question and photo. Yes, you are an excellent candidate for a rhinoplasty. The cartilage under the tip of your nose would be reshaped for improved tip definition, without breaking the bones in your nose.
I recommend consultation with a board-certified plastic surgeon who specializes in rhinoplasty. They will discuss your goals, examine you, go over virtual simulation pictures, and review before and after photographs to give you an idea of what type of result you can expect to get.

Thomas J. Walker, MD, FACS · Answer

The short answer to your question is that the extent of surgery depends on the intraoperative findings and it is best to let the surgeon decide what is best. With that said, "hammering" of the bone (osteotomies) are often not necessary. The majority of rhinoplasties I perform do not require osteotomies. However, osteotomies are not a problem and just slightly increase the risk of bruising on the cheeks and have prolonged restrictions in terms of when one can wear glasses/sunglasses again or perform contact sports. I encourage you not to focus on the various steps of what is done during surgery (frankly, surgeons don't know every single step of the surgery prior to the operation as many decision are made intraoperatively based on the findings) but rather focus on finding a surgeon you are comfortable with, trust, and whose before and after photos are in line with your expectations. Best wishes!

Philip K. Robb Jr., MD, FACS · Answer

What you're referring to is called a "tip rhinoplasty." In this procedure, the cartilage around the tip is altered slightly to create a slimmer, more defined appearance of the nose. The bone is not touched. This results in no bruising or prolonged recovery. 
Hope this helps and God Bless!
Dr. Robb

Ashish Davalbhakta, MBBS, MCh(Plast), FRCS · Answer

What I understand from your question is, can the lower third of the nose be narrowed, without touching the bones. You want to know if cartilage can be removed. In Short, the answer is yes, it can be trimmed and cut without doing a bony fracture. In long, the lower third of the nose is made up of not only cartilage, but fat and skin as well. So, the lower third of the nose may look wide, big, or bulbous, not only because of large cartilages but also due to thick skin and fat. Narrowing the lower third of the nose can be done by suturing the cartilages narrower, and sometimes trimming them judiciously. However, if the wide bulbous lower third of the nose is due to thick skin and fat, then cartilage narrowing or trimming may not yield satisfactory narrowing.

Robert Singer, MD · Answer

Improving the nostril width and refining a flaring tip to achieve an improved natural appearing cosmetic result are frequent requests 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 photo 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

Paul N. Afrooz, MD · Answer

Each rhinoplasty is tailored to meet the patient's goals and create the desired change.  If you determine that you do not want your nasal bones to be altered, and your surgeon agrees based on your goals, then it is certainly not required.  Manipulating the nasal bones is done only if necessary, and a rhinoplasty does not need to include this.  
Based on the photo you have provided, the change that you desire can be achieved by surgically addressing the cartilage components in the lower 1/3 of your nose.  Trimming and shaping these cartilages will make the tip of your nose smaller, more defined, and enhance the appearance of your nose.

Jordan Rihani, MD · Answer

Changing the tip of the nose rarely requires any adjustment of the bone. If you do require changed in the hump of your nose, sometimes the bones on the side of the nose will need to be cut. This would best be explained in a consultation where you would have time to discuss your surgical goals and options for treatment.

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