The bulbous tip is best addressed with intra-domal or inter-domal suture techniques to the lower lateral cartilages. In some patients a conservative cartilage( cephalic trim) removal is also performed, but not all patients. Some patients require a columellar strut when there is poor tip support, but in our practice we don't use them very often. All rhinoplasties are performed under general anesthesia for patient safety and comfort.
I would not worry about a pinched appearance. I have not seen one from the hundreds and hundreds of tips I have done. There are a multitude of techniques beyond those mentioned that can be utilized.
Find a board certified plastic surgeon who performs hundreds
of rhinoplasties and rhinoplasty revisions each year. Then look at the
plastic surgeon's website before and after photo galleries to get a
sense of who can deliver the results.
Kenneth Hughes, MD
Los Angeles, CA
Tip work will vary from patient to patient. In many cases a cephalic trim is performed with tip suturing as well. It is always best to be seen in person.
Much of what you ask is technical and may not even apply to the rhinoplasty you need. Future pinching is prevented by leaving adequate support to the tip and airway. Best way to go about things is seeing a board certified plastic surgeon in your area.
Usually a dome binding suture and a columellar strut are used during an open rhinoplasty procedure. You may also be a candidate for a closed rhinoplasty.
The cephalic trimming gives the nasal tip definition and refinement not pinching.
Without the benefit of pictures or an examination, I am at a disadvantage giving medical advice. A rhinoplasty including a board certified professional fee, a board certified anesthesia fee, and an accredited Medicare approved surgicenter is $4100. Consult with a Board Certified Plastic Surgeon.
You have some very good questions with regard to specific surgical maneuvers that can be done during a tip rhinoplasty. The approach to each nose should be tailored to the individual's concerns and anatomy. In some cases cephalic trims may not be required as you suggest. The "success" of dome shaping sutures can be influenced by a number of different factors including the skill of the plastic surgeon, thickness of the nasal tip skin, and strength of the dome cartilage. I highly recommend searching for a plastic surgeon in your local area to answer your questions. If the surgeon you meet can't answer these questions with clarity, move on and find another one who can. Thank you for sharing your questions. Best wishes.
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