Cephalic Trimming and No Suturing at All?

Hello Luna,  While cephalic trimming without sutures can be a good alternative for some patients, the procedure must be carefully selected for the right patient.  Modern rhinoplasty techniques use more conserving techniques to avoid indentations, contracutres, and deformities associate with the "operated look".  In your case, it would be best to see your pictures to determine weather this may be a good option.  Thanks.  Dr. Torkian

Hi Luna, you have an amazingly technical question. Suture control for correction of the lower lateral cartilages of the nose are one of the maneuvers that are used in the bulbous tip, in addition to relocation of the lateral crus of the lower lateral cartilage. It should have no effect on the structures above. Cephalic cartilage trim alone is not as powerful and would not provide ideal correction in the truly bulbous tip. The key is diagnosis which then determines the ideal treatment. The maneuvers your surgeon uses is based often on their own individual techniques and ultimately the result itself not the technique is important. Seek out a Plastic or Facial Plastic Surgeon with a good experience in rhinoplasty to do the surgery and then trust that surgeon to listen to and address your concerns. 

yes and no.  it all depends on the nose.  often the bulbous tip has wide can firm lower lats that are alos convex and oriented toward the inner canthus.  reducint the cephalic portion of the cartilage will address the width but not other contributing anatomy.  in particular convexity and orientation need to be addressed. sutures are often needed to do this.

Hi there,

What an amazing question you ask!  I'm always surprised how much patients know these days.  Internet access, and excellent sites such as Realself, allow detailed research.

Your question is a complex one, even if you think it may not be. It relates to the skin thickness, the size, shape and most importantly orientation of the lower lateral cartilages, and the relationship of the tip to the bridge in your case.

Only an examination of your nose will allow a precise answer to the question  for your particular nose.  But as a general comment, the area just above the alar groove is very important in nasal aesthetics.  However the bulky tip is handled, if that area remains full, the nose doesn't look good from the front or three quarter view.  

Options for handling the LLC include trimming (less and less done by me these days as it has a number of negative consequences), intracartilaginous resection, shortening, softening or reorienting it.  In the bulky tip I often release and rotate it down if it has a more vertical orientation - which I think is what your question is referring  to. Handling a bulky tip can involve skin thinning, although rarely.

To summarise, planning how to manage the LLC goes to the heart of a good natural result in a rhinoplasty for a bulky tip. Every case needs a plan, made through analysis in the office and not made in the operating room on the day. A number of techniques are used, and attention needs to be paid to function, plus the production of a finer tip which harmoniously blends with the upper part of your nose.

On rare occasionsit may be possible to achieve some tip refinement with cephalic trimming only.  However the sutures provide stability and control, ensuring a better result.  Dome sutures should not causea bulky appearance above the margin of the lower lateral cartilages.  Other maneuvers must have been done in this area to create what you have appreciated on photographs where dome suturing was performed.  If suturing is not performed the ability to narrow the tip is dramatically compromised.  I would recommend that you discuss your concerns with your surgeon and avoid trying to learn rhinoplasty techniques as there are many approaches to accomplish the same cosmetic outcome.The best results are more dependent on the surgeon than the technique they use.