Boxy Tip Versus Round Tip. Advice Needed ASAP!

Hi I'm getting rhinoplasty in 8 days and my doctor said he'd like to refine my tip by suturing the spaced-far-apart cartilages together to make a smooth, round, "almond"-shape because when he shaves down my dorsal bump and reduces my radix, the boxy tip will look more enlarged than it actually is. However, I like my boxy tip. I need some second opinions. Should I keep my boxy tip or would I be better off with a narrower, rounder tip? I need to tell him on the day of my operation. Please Help!

Doctor Answers 13

Boxy tip

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Yes your tip is bifid (split). No your tip isn't boxy. And, I too like your tip.  An artist, not a scientist would appreciate what you like and don't like about your nose and advise you. Personally I would reduce your hump (slightly) narrow the base (minimally) turn the tip up and leave it looking like your tip. You-tube Linda Evangelista and you'll see what I would want your nose to look like. A Michelle Pfiffer (You-tube her also) would look bad on you. Cosmetic surgeons should be scientists (board certified plastic surgeons), but they should also be artists...and only you can tell who's an artist and who's a scientist only. Good luck and stick to your guns.

Waldorf Plastic Surgeon
4.5 out of 5 stars 34 reviews

Rhinoplasty Plan Should Be Formed Well Before Day of Surgery!

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Hi Talli,

The most important aspect of your nose to recognize before rhinoplasty surgery is that your lower lateral nasal cartilages are oriented vertically as opposed to horizontally, something rhinoplasty surgeons refer to as malposition or a "parentheses" tip.  Your lower lateral cartilages need to be repositioned properly, and refined.   Rhinoplasty surgeons should have their planned operation in mind long before the day of surgery based on proper diagnosis of the patient's underlying nasal anatomy and structure.  Granted sometimes we do make small decisions once the nose is opened, but in your case, your boxy tip should definitely be addressed as should the malposition of your lower lateral cartilages.  Better to have the proper diagnosis and plan long before the actual day of  original surgery than to require a well thought out plan for your revision surgery.  Good luck and be well.

Dr. P

Michael A. Persky, MD
Encino Facial Plastic Surgeon
4.8 out of 5 stars 39 reviews

Boxy or Narrow Tip?

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The paried cartilage that shape the tip of the nose are shaped like the letter "M". Bringing the top of the "M" together will narrow the tip. This is usually done with sutures. You have to happy with your nose so you should do what you would like. However, I think you should consider narrowing your tip as that would make your nose more consistent cosmetic ideals. Good luck. 

Benjamin Dunkley, DO
Salt Lake City Facial Plastic Surgeon

Something to discuss before the day of surgery

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Dear Taliin, I firmly believe this is something you should discuss well in advance of surgery.  The day of surgery is a very anxious period and not a time to make that decision.  If you are asking advice from doctors in this blog then I am happy to offer this.

I would correct the bifid boxy tip with an open rhinoplasty.  I would reshape the tips and repair the cleft between the 2 lower lateral cartilages.  The important thing to do is to keep the nose in balance for an aesthetic appearance.  Changing one portion of the nose has a definite effect on the way other areas of the nose look.  The other point you might want to discuss is a chin augmentation to balance the face, although this is a very personal decision and some of what I am seeing may be photographic distortion.

If your doctor has computer imaging that might be helpful in assisting you in your decision.  Good luck with your upcoming surgery.  Dr. Schuster in Boca Raton, FL.

Nose tip

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Your boxy tip is what we call a bifid tip. This caused by too much space between the lower lateral cartilages. This should be corrected. If you trim the tip cartilages and do not correct this you may may well end up with bossae.

David A. Bray, Sr., MD
Los Angeles Facial Plastic Surgeon

Boxy Tip Versus Round Tip. Advice Needed ASAP!

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Boxy Tip Versus Round Tip. Advice Needed ASAP!  My only concern would be that if an open Rhinoplasty is to be used to suture the nasal tip cartilages together, this cause IMHO, tip rotation of 5-7b degrees which would over-rotate your nasal tip making it appear short and pig-like.  If it's through a closed Rhinoplasty, then this would not be an issue.  I have performed Rhinoplasty for over 20 years and it's not what you want to have done but rather what can be done to make your nose more naturally attractive...

Francis R. Palmer, III, MD
Beverly Hills Facial Plastic Surgeon
4.7 out of 5 stars 28 reviews

Boxy vs round tip

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After reviewing your photos i would agree with your surgeon in that performing a radix and dorsum reduction will make your tip appear larger.  However, there is a much larger problem here.  You and your surgeon are not on the same page.  Do not wait until the day of surgery to discuss this further.  Call him/her immediately to have further discussions until you feel that they understand what it is that you want and are willing/able  to perform the surgery.  Remember, it's your nose so the decision is ultimately yours and yours alone. 

Donald M. Brown, MD (retired)
San Francisco Plastic Surgeon

Should a boxy or bifid tip be changed?

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You don't have to change the tip boxiness or bifidity if you don't want to. In the right hands it can be a subtle change. You should discuss this with your surgeon. Ideally he or she could perform computer morphing to show you what type of change is expected.

Ultimately, the decision is yours, of course, based on your overall preference.


Thomas A. Lamperti, MD
Seattle Facial Plastic Surgeon
4.9 out of 5 stars 22 reviews

Rhinoplasty for the bulbous tip.

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Yes, your tip is boxy, but if you do not have alar grafts for your vertical cartilage malposition you will have a pinched tip. You may want to postpone your surgery until you get another opinion from an experienced rhinoplasty surgeon.

Toby Mayer, MD
Beverly Hills Facial Plastic Surgeon
4.8 out of 5 stars 38 reviews

Set your rhinoplasty goals well before your procedure

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Most we see for rhinoplasty have disliked their nose for many years, and some idea of what is wrong, and which direction they wish to go. Well before any procedure, we work with photos and computer imaging to determine just what the end result is meant to be, and arrive the day of surgery with a clear plan and understanding. If you are deciding what is right for you the day of surgery, you are unprepared.

Best of luck,


Peter E. Johnson, MD
Chicago Plastic Surgeon
4.0 out of 5 stars 44 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.