Will my tip still look droopy if I only get the hump removed ? (photos)

Question

I had a consultation a month ago and the surgeon told me he would preform a closed rhino to remove the hump. He said he would aim for a natural looking nose. I am just wondering if the tip will look as droopy he only works on removing the hump.

Matthew Bridges, MD, FACS · Answer

Excellent question.  This is a nose that very well may need a bit of extra tip projection to make sure the tip up tends beyond the reduced bridge slightly.  This is the problem with "simple" closed hump reduction.  There is a point where the bridge cannot be reduced anymore and the tip must be augmented to achieve a straight profile.   If the surgeon performing the procedure is not skilled in performng closed tip augmentation, he would either have to convert to open or otherwise compromise the result.   See the link below for an example.

Steven M. Denenberg, MD · Answer

When you lower the bump on the bridge of the nose, it almost always makes the nose look longer. "Longer" meaning that the tip looks lower and droopier! A closed rhino on you to only remove the hump sounds like a disaster to me.See the "Web reference" link, just below my response. I made a computer morph, and an animation of the morph, to show the changes that are possible for your nose in truly expert hands. I took down the hump, but also elevated the tip. Then, I moved the entire nose a little bit closer to your face, to further decrease its prominence.I also made a simulation showing what your nose would look like if only the hump were removed. Check it out. Not good.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.

Alejandro Nogueira, MD · Answer

Your tip is not a droopy one, under no point can be named as such, yours is a poorly defined tip, with unsuitable location of the maximum projection and suboptimal shape. This is well and best treated with tip grafting, Sheen's technique of shield graft, a difficult and creative gesture which few surgeons master or are keen on performing, but in expert hands leads to awesome results.If tip grafting is not carried out in your nose you will not have a bad result (as long as the hump is properly treated and the osteotomies well done), but the tip would remain the same, with the same poor definition.If you are ambitious in your goals you'd rather seek the opinion and treatment of a surgeon trained and used to apply tip grafting as a routine in his surgeries; the look of a well applied tip graft is simply amazing.Let me note not all the noses have indication of tip grafting, in my practice about 1/3 of the cases have absolute, relative or elective indication of tip grafting. In other cases the tip is treated with plasties (like Ortiz-Monasterio's domes plasty), plications with sutures, struts, shortenings, etc.Tip grafting can theoretically be done with closed approach by means of a marginal counter incision at the rim of the nostrils, but I strongly adice open approach which allows perfect location, tailoring, and fixation with sutures, thus minimizing the risk of artificalness, dislocation or wrong sizing.Do research about backgrounds, experience and reputation in tip grafting.

Eric M. Joseph, MD · Answer

There are ligaments from the nasal bridge to the nasal tip that naturally get disrupted after removal of a nasal, dorsal hump. If tip-plasty and support is not performed after hump reduction, the result may be worsening of your droopy tip.Thank you for this excellent question.My best.Dr Joseph

William Portuese, MD · Answer

Remember, the nose is a three-dimensional structure  and the side profile is only one dimension. When performing a rhinoplasty, it's important that the dorsal hump is removed which is composed of both bone and cartilage. Once the hump has been removed, osteotomies are performed and the nasal bones to narrow the bridge line. Once those 2 maneuvers have been accomplished,  it is important to evaluate the nasal tip. The tip may need to be rotated upwards and refined and narrowed based on a full set of facial photographs. For more information and many examples, please see the link and the video below

William H. Sabbagh, MD · Answer

Hi sd1745, If only the bump on the bridge is removed then not only will the tip of your nose droop more, the bridge will become flatter and wider.  To obtain a natural result it is generally necessary to address all parts of the nose. If the bump is removed it will create an open roof deformity making the bridge flat and wide.  To correct this the nasal bones need to be fractured to move them back together so the bridge does not appear wider.  In your case since the tip already is somewhat droopy it would need to be elevated and shortened and also thinned slightly.  These thing would give the most natural and best outcome.  Open or closed would be whatever surgeon feels he or she can obtain the best results with.

J. Charles Finn, MD · Answer

Yes, it might still look droopy, especially with a full smile. The nose will certainly look a bit long without some tip elevation. Ideal tip rotation depends on many factors, including your height. For a tall woman, less tip elevation looks better while for a petite woman more tip elevation may look better.  Another factor to consider is that a nasal tip tends to droop more with aging, and rhinoplasty is a chance to decrease that effect. Your best bet is to see a surgeon with a great deal of expertise in rhinoplasty who has computer imaging to show you your possibilities.

David Reinstadler, MD · Answer

This is a good question. If you imagine that your profile currently makes the tip look a bit droopy because the high dorsum appears to push down the tip. When the bump is removed, it should make the tip look more appropriate without doing anything specific with rotation or projection. If you have any specific concerns, I would recommend visiting with another surgeon who can do an in person examination and give you more specific advise. Best of luck

Francis R. Palmer, III, MD (retired) · Answer

Hi, I have performed many Rhinoplasty Surgeries over the past 30 years.  From the photos, your nose has a dorsal hump, an under -rotated nasal tip (makes the nose appear long) and I suspect the chin may also be weak (although a full profile is needed to verify that).  Rhinoplasty can reduce the dorsal hump but if the tip is not raised, it will continue to be under rotated. If the chin is weak, this creates an imbalance making the nose appear larger, the mid face top heavy and the lower face look short that de-emphasizes the lips and allows early formation of a double chin.  Chin augmentation using a chin implant will add projection to the chin creating harmony and balance to the lower face.   I have found that placement of a silastic chin implant, through a small curved incision under the chin (also allows excess skin removal) to be very safe, quick and highly effective.  I frequently combine Rhinoplasty with chin implant placement to achieve facial harmony and balance.Hope this helps.

Michael Elam, MD (retired) · Answer

Dear sd1745, The nose is a three dimensional structure and all aspects must be taken into consideration when refining the nose in order to have a natural result. You never just reduce the hump without taking into consideration the rotation of the tip to the dorsum. Rhinoplasty is performed to bring balance to the profile and the overall facial aesthetics. Seek consultation with experts in the field of rhinoplasty, read their reviews on real self and make sure that they devote a large portion of their practice to rhinoplasty surgery, look at their before and after photographs to ensure they perform natural looking rhinoplasty surgeries and then make an informed decision. See the link below and video above for examples of how rewarding this procedure can be. Best regards, Michael V. Elam, M.D.

Will my tip still look droopy if I only get the hump removed ? (photos)

Answers (11)

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