Bulbous wide nose tip, is it possible to have work done without the bridge being touched? (Photos)

Question

Hello, This time, I am attaching my side profile. I want to have a rhinoplasty without any work done on my bridge. I’m only interested in work on my tip and alar. Is this possible? I don’t like my big, bulbous, wide tip. Can you look at my side profile and let me know if it needs any work? Is it possible to have the procedure done without the bridge being touched? Will this be enough to achieve a balanced look? Also, will I need skin grafting for this procedure? Will the healing be faster? Additionally, can this procedure be done under local anesthesia and sedation? The only thing holding me back from rhinoplasty all this time has been the fear of general anesthesia. Thank you for your advice

Arturo Valdez, MD · Answer

In order to achieve an adequate balance between the nose and the face,  I have to work on both the dorsum and the tip of the nose. The nose ins classified according to race. Your nose  have what is known as an ethnic nose, meaning these patients typically have thicker skin, the skin at the tip very thick and your the cartilages are wider and weak.  If only the nasal tip is corrected there will not be a balance between the dorsum (bridge of nose) and the tip of the nose. Also, in addition, we would most likely need to perform a cartilage graft, not a skin graft. Cartilage offers better support and definition at the tip of the nose. Surgery on only the tip is not an option for your situation.  I prefer to perform this type of surgery using general anesthesia, not local anesthesia and sedation. I understand your apprehension, but general anesthesia is very safe as long as you are a healthy patient and in ideal condition for surgery.
Hope this helps, and I wish you the best.

Andrew Miller, MD · Answer

Based on your photos, you are a good candidate for tip rhinoplasty. Your tip cartilages are wide and this can be refined while doing nothing to the tip at the same time. Be sure to see a rhinoplasty expert for consultation.

Eric M. Joseph, MD · Answer

Based on your photos, the lower 1/3 of your nose appears to be over projected in both the tip and bridge. I believe that bridge lowering would be beneficial for improving your nasal profile appearance. We feel strongly that general anesthetic is the safest way to protect somebody's Airway during elective rhinoplasty surgery. Sometimes an anesthesiology consultation is helpful for people with concerns about general anesthetic. I hope this helps! Sincerely, Dr Joseph

Zoran Potparic, MD · Answer

It is very likely, based on these photos that you may end up with good result having tip refinement surgery. It can be done in local anesthesia and, if needed, your surgeon can use fresh frozen cartilage grafts instead of your own septal cartilage. In that case the entire procedure can be done in local or twilight anesthesia. In person or teleconference consultation with a board certified plastic surgeon, expert in rhinoplasty, is recommended. Good luck.

Oakley Smith, MD, FRCSC · Answer

Hi, It is better for you to consult with a facial plastic surgeon who can examine you and give you opinion based on your needs and expectations. Surgery done under general anesthesia, no need for skin grafting.

John Michael Thomassen, MD · Answer

A tip rhinoplasty can be done without touching your dorsum.  It can be done under IV sedation.  Reducing your lower lateral cartilages and suturing them together, also orienting them less cephalic will give your tip a more pleasing shape.

Paul E. Chasan, MD, FACS · Answer

Thank you for your question. You are an excellent candidate for rhinoplasty. I think it is one of the most beautifying surgeries that we do as plastic surgeons. A large portion of my practice is dedicated to rhinoplasty surgery. It is important to only see plastic surgeons with extensive experience in rhinoplasty, ie perform at least 6 per month and have performed hundreds of cases. Also, critically evaluate on-line galleries to see if their art form resonates with yours. Rhinoplasty is definitely a grey haired plastic surgeon's sport. Best wishes to you.

Gary M. Horndeski, MD · Answer

From your side view, your bridge does not need to be modified. However, your lip nose angle needs to be increased. You also have a lot of columella show and your tip is somewhat square and needs to be refined with a rhinoplasty. Doing this under local anesthesia would be very difficult and I would recommend general anesthesia.

Best Wishes,

Gary Horndeski, M.D.

Best Wishes,

Gary Horndeski, M.D.

Richard G. Reish, MD, FACS · Answer

Hello and thank you for your question. Based on your photographs, you are a great candidate for rhinoplasty. Maneuvers for your surgery would include dorsal hump reduction, tip refinement, nasal tip deprojection, tip elevation, among other maneuvers. For the best and safest results, this should be done under general anesthesia. With good surgical technique, you could have an outstanding result. I recommend that you seek consultation with a qualified board-certified rhinoplasty surgeon who can evaluate you in person.

Best wishes and good luck.

Richard G. Reish, M.D.
Harvard-trained plastic surgeon

Best wishes and good luck.

Richard G. Reish, M.D.
Harvard-trained plastic surgeon

Ruslan Zhuravsky, DO · Answer

Hi, Yes it is possible to change the tip without changing the bridge. It is very important that you do morphing software with your surgeon to understand what that new tip would look like with your current structure. In many cases we change all aspects in order to maintain proportions, but in some cases patients are happy with changing only specific aspects.A special note on your specific tip is that your tip cartilages are very convex in shape. When these cases are treated with simple reduction and suturing, we usually see very unfavorable results and deformities such as retracted nostrils, pinched tip, round shape tip with dented sides, etc...Also, when a large tip is made smaller, you often have to reduce to nostrils to maintain proportions. These are things that you should discuss and visualize with computer images during your consultation. Please make sure to choose a not just a board certified facial plastic / plastic surgeon, but also one that specializes in high quality rhinoplasty surgery. Good luck!

Bulbous wide nose tip, is it possible to have work done without the bridge being touched? (Photos)

Answers (12)

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