I have a much bulbous tip and a hump at my bridge. My tip is so thick and heavy that it makes my tip droop. It seems like it makes my profile appear worse than it really is with the hump. Is there anyway just the tip could be fixed? I feel like if the tip was reshaped the profile would improve a great deal. Is it possible to avoid everything else that is involved with rhinoplasty, if you only reshaped the tip. Is is possible?
Doctor Answers 8
Tip rhinoplasty can be done alone.
Sometimes, sculpturing the tip is all that's needed, but I would advise you to let an expert plastic surgeon make a surgical plan. Make sure you understand all the details before you decide that the tip is the only thing you want fixed. Treating other parts of the nose, like the hump, is safe and reliable.
Tip alone can be modified with Rhinoplasty
Of course, the tip alone can be thinned using a Rhinoplasty...most likely an Open Rhinoplasty if your nasal tip is also under rotated as this procedure increase tip rotation, IMHO. If you want to keep the bump, in your nose, and understand the nasal aesthetics involved with that decision...it's absolutely your right and decision to do so. In that scenario, you'd have an open or closed tip plasty depending on the current shape of your nsasl tip. No cast, no nasal packing.
Tip-only rhinoplasty - not always possible
Everyone’s nose is different, and for some people a tip refinement rhinoplasty is possible, while for others it is not a good idea. Based on what you are describing, you could either have think skin with a bulbous tip and strong cartilage, or you could have weak / floppy tip cartilage and a “tension tip” where the dorsal septum is holding the tip up (even though the tip would appear to be hanging).
- In the first case, tip-only refinement is possible (though you might be short-changing your result by not addressing the dorsal hump).
- In the second, weak-cartilage example, attempting a tip-only rhinoplasty would result in a disaster. The act of unroofing the cartilage so it can be seen and manipulated destabilizes the supporting structures of the tip, and if the cartilage is weak to begin with, it may not be strong enough to support the skin during the healing process, and the whole tip may collapse.
While it is reasonable to request only tip changes, it is vital that you let the surgeon decided on the technique. You should visit with an experienced rhinoplasty surgeon who does a physical exam and explains the logic of the operation that they propose. For someone with a tension tip and weak cartilages, even if you only want tip changes, you will likely need a septorhinoplasty so that septal cartilage can be harvested to be used a building material to support the tip (eg: columella strut and lateral crural strut grafts).
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Bulbous, Droopy Nose Tip
The tip cartrilages can be reduced or the contour changed to improve appearance of your tip. Although little can be done to change the thick overlying skin, the tip can be improved with surgery. You and your surgeon will decide if anything else should be done to achieve the best possible result.
Thick, rounded nasal tips are one of the most asked about features in rhinoplasty. If the cartilage under the skin is firm and rounded, it can be modified to reduce prominence and width. If the tip is underprojected increasing the height may make it look thinner. Thick and sebacous skin is a different, and tougher problem. Thick skin is like a covering fine details with a fluffy blanket. The subtle cartilage changes just don't show through. Trying to thin the skin is rarely helpful. Therefore the answer to your question really rests in a consultation with an experienced rhinoplasty surgeon to find out what your anatomy and skin will allow.
Thick nasal tip skin and a bulbous tip
If the dome cartilages under the nasal tip skin are large and rounded, then you are in luck in that these cartilages can be trimmed and then reshaped with sutures, giving you better tip definition. If on the other hand, the roundness to your tip is all due to thick skin and the cartilage underneath is weak, then there is less that can be done. Sometimes with thick skin, the tissue underneath can be thinned out, but this must be done conservatively and carefully. Some individuals with thick tip skin benefit from a tip graft that increases tip definition. Some lasers can thin overlying nasal tip skin and some medications can decrease pore accumulations and size. If you are going to have a rhinoplasty and you also have a dorsal hump, it would make most sense to have that addressed at the same time.
If you have the tip refined, the hump will be problem afterward and you will want to correct it too. Rhinoplasty is a procedure to reshape all nasal components. There are certain proportions that must be maintained to achieve an ideal nose. Changing one component will affect others and therefore, all components need to be refined to have an ideal shape.
Poissible, but the nose is a whole feature
A bulbous tip is partly bulbous because of the cartilage, but also because of the skin. If skin is thick, as it often is when the tip is bulbous, only limited reduction is possible. Even when the skin is thin there are limits.
However, the tip belongs to the rest. Often the upper nose looks too small for the lower nose. Because skin tightening beyond a certain point is not possible, the best solution is often to reduce the tip as much as possible consistent with getting a nice shape, and then to raise the bridge to blend with the tip (keeping it straight but 1-2 mm higher). Thus the tip also becomes smaller because the nose is in much better balance. I do this all the time and have written about it. The important principle is for the surgeon not to do something that Nature will not allow. You want a successful, pretty result--not just a smaller nose at any cost.
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.