Do I have a significant dorsal hump? Can just a tip plasty fix my droopy nasal tip? (Photos)

Question

41 year old female, droopy nasal tip that is also bifid. Do I have a significant dorsal hump? Can just a tip plasty fix my concerns?

Mark K. Markarian, MD, MSPH, FACS · Answer

Hello and thank you for your question.  Although an exam in person is ideal, from your photographs alone it appears that you can benefit from a subtle dorsal hump reduction and a tip rhinoplasty where the nasal tip cartilage is modified for a more refined, feminine look.  The tip droop would specifically be addressed with extended spreader grafts locked into a columellar strut graft.  The modification of your nasal cartilage can be done with trimming, stitching or grafting.  If your septum is deviated and you have breathing difficulty, a septoplasty may benefit you as well -- insurance can cover this and reduce the price of your surgery☝️

The next step for you is to find the right aesthetic plastic surgeon.  In your rhinoplasty consultation, be sure your surgeon addresses all your aesthetic goals and concerns specifically, and discusses the surgery details including the position and size of the incisions used (with actual photographs and not just digital animations), the risks and benefits of the procedure, recovery time, and post-operative course.  Also, be sure to see plenty of before-and-after pictures in women who have a similar nose appearance to yours, and preferably at different time frames (3 weeks out, 3 months out, etc) to more accurately predict your own surgical outcome.

After seeking out a board-certified plastic surgeon who specializes in aesthetic plastic surgery, I think the most important component of the consultation is to establish a good connection with your plastic surgeon.  It’s the connection that allows you to clearly define your desired nose outcome goals, the first step of this whole process. If you don’t feel you have a good connection with your plastic surgeon after your consultation, he/she may not be the best surgeon for you.

For more information on rhinoplasty, please refer to my link below.

Good luck and please let me know if I can help.

Mark K Markarian, MD, MSPH, FACS
Harvard-trained Board Certified Aesthetic Plastic Surgeon

Jeffrey M. Darrow, MD · Answer

Thank you for your photos.  It does not appear that you have a large dorsal hump, although your nasal dorsum could be lowered a millimeter or two in order to refine your dorsal appearance. To improve your nasal tip contour and position would likely require some excision and suture shaping of your lower lateral cartilages plus a septal extension graft to project and elevate your nasal tip so it has strong support to correct your nasal tip droop.  This is a little bit more involved than just a tip plasty of your nose, but would give you the overall best results. Discuss this in detail with your plastic surgeon. Best wishes.

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. 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

Tanveer Janjua, MD · Answer

You have a droopy tip and a retracted angle between lip and nose. You can lift your tip with a TLC tip plasty. (Trans Labial Columellar) tip plasty. It can be done under local or general using either your ear cartilage or rib cartilage. 
Regards
Dr. Janjua

Paul E. Chasan, MD, FACS · Answer

Thank you for your question. You are an excellent candidate for rhinoplasty, but do not think just the tip-plasty would be sufficient. 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.

Steven M. Denenberg, MD · Answer

It almost never happens that a nose has some modification on the tip and *nothing* else. For example, on your nose, if you were to have surgery, why not lower that tiny bump a little bit? On someone else, if the tip gets narrower with surgery, now the bridge might look too wide, so the bridge should be narrowed, too. Stuff like that.
But yes, your dorsal bump is pretty small, and you'd decide whether you like a little bump or have the bridge be straighter or even a teeny bit concave. And the main event would be elevating that tip.
How *much* to elevate the tip, or lower the bump, or make other changes? We figure that out with morphs, well before surgery. I'd love for you to see some excellent professionally-designed morphs of what could possibly be done with your nose. Morphs could also help you identify better just what's bothering you, and help you set a goal for the rhinoplasty that's accurate for your tastes. Profile and three-quarter views would be particularly important in morphing your nose. (Side note: in my opinion, morphs should really be done by the surgeon, or he should direct an assistant as she makes the morphs. Morphs should be made with a constant eye to what actually *can* be done in surgery, for that particular nose, and the surgeon has that information and judgment best.)

Finally, remember that rhinoplasty is an exquisitely difficult operation to get right, and you should only have surgery if you are able to make yourself very confident in your surgeon's skills. The changes that your nose needs -- particularly that large elevation of the tip -- require advanced techniques, and skill that most plastic surgeons don't possess with expertise. You don't want to be in the position after surgery of looking at a nose that's still too long. It's much better to not have surgery than to have inexpertly-performed surgery.

Andac Aykan, MD · Answer

Hello, thanks for your question as well as your photos.
You do have a visible dorsal hump, and your tip is both droopy and separated (bifid). A tip only procedure would not correct the hump, and lifting the tip without smoothing the bridge would actually make the hump look more pronounced.
To fix your main concerns, you would need a rhinoplasty that includes hump reduction plus tip refinement and rotation. This gives a smoother profile and corrects the droopy, bifid tip at the same time.
Andaç Aykan, MD, Assoc. Prof.

Darryl J. Blinski, MD · Answer

Based on the two angular post photos, which are not as helpful as frontal side views, I recommend a virtual consultation for better understanding, but in my opinion, you need a full rhinoplasty not a tip. Plastic attained the goal you wished. Expect fees to arrange from $8000-$12,000. Best of virtual concert with.

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