Can I Elevate my Tip to Disguise my Hump Without Dorsal Rasping?

I think the better way to improve your profile is to build up the bridge of your nose in the area called the radix.  This is the portion of your bridge above your hump.  This will give you a more feminine profile, while making your nose and face appear slightly more narrow.  Removing the hump will make your nose appear wider.  Rotating the tip will not have a significant effect on the appearance of the hump. 

In my opinion, you do need something to stabilize the tip.  This usually is done with a columellar strut, but can be accomplished with other techniques as well (ie the septal tongue-in-groove maneuver).  You are right that by first projecting your tip, the amount of reduction of your bridge will be less.  You have basically a "pseudohump" caused by a low radix (the starting point of the nose) and an underprojected tip.  The key to having a long-lasting and pleasing result for your nose is stable tip projection.

The approach to rhinoplasty is very individualized.  In general, I agree with Dr. Lee that your tip should be augmented with cartilage tip graft in addition to slight elevation of the tip.  Upward tip rotation, in my hands, is predictably accomplished by trimming lower lateral cartilages, caudal septum, tip graft, and potentially, suturing to septum.  Lowering the dorsum and/or augmenting the radix (top of the nose) won't really add much down time, although it may add some cost, but will improve your overall result considerably.  Treating the tip alone will NOT camouflage the dorsal bump.  

You are young and beautiful.  If the nose bothers you, and the dorsal hump bothers you at all, I would treat the dorsum as well.  It will be worth it many times over in the long run, provided your result is good.

The nose can be improved by giving more tip projection. However, you'll need more than suturing in order to accomplish this. The cartilages at the tip are very soft and will need reinforcement with additional cartilage in order to get the tip projection and strength you need. Also, you can place a graft, usually temporalis fascia, in the area between your eyes (radix) in order to make the bridge more straight without rasping the hump. 

 

you absolutely can do this. I have a number of patients who have this procedure done where I placed a cartilage graft on their columella or under their tip to support the tip and hold it up. I get patients from China and other parts of Asia frequently for issues very similar to yours. Often times in China surgeons will recommend you use an implant but you should not do this. This appears to be medium thickness skin with a simple issue of what we call top ptosis. You need to elevation which is a surgery that requires a highly skilled and experienced surgeon but in general is not a very large surgery and you should heal within one to two weeks. Do not use an implant. As you raise the tip the hump on your nose will be less apparent. I can tell it was not always this way. I can tell that you are in your 30s or older and that your tip when you're younger was not as low as it is now and the hump on your nose was not as obvious as it is now.

Chase Lay, MD

double board certified facial plastic surgeon

Asian facial plastics specialist

The tip cannot be raised high enough to make the hump go away.  The hump will need to be surgically removed.  A small hump can be simply rasped but a large hump will require osteotomies.  In addition, the depressor septi ligament of the tip will need to be softened to prevent the tip from drooping upon smiling.  To raise the tip, suturing techniques of the nasal tip cartilages will need to be performed.

I agree that raising the nasal tip would be a good way to improve your profile.  This can be done without cutting any cartilage out.  However, the small nasal hump you have will still be present.  If you like it, you can avoid rasping it down, but to have a straight profile, it will need to be very slightly rasped.  I don't like using silicone in Asian Rhinoplasty surgery

Hi Shanghai;

I understand your thought process, and it is a good one.  Your photographs are also very helpful.  I am sure that when you raise the tip of your nose, the migration upward makes the bump look like it is going to be gone. 

In the operating room, that will not happen.  You need to have the bump removed.  When the tip is rotated up, you will certainly have a better profile.  I do appreciate the fact that when you smile, the tip plunges, which is because you have a very active depressor septi muscle, which your cosmetic surgeon will certainly manage properly. 

The most important thing: when you have rhinoplasty, all the elements must be considered and dealt with.  The ports of the nose are connected to each other, and a change in one can affect the appearance, and even function, of the adjacent area.  That is why the rhinoplasty surgeon engages in a lot of thought when performing the procedure.  He has to understand what changes occur, not only in the tissues he is operating on, but on those adjacent tissues, and how they will heal. 

In your case, the bump should definitely be removed; although, it can be done very conservatively, certainly.  I do not know that you necessarily need to have an implant.  The tip will come up, but if your preference is to have a stronger tip, you may want to have an implant, or the use of some filling injections at some point.

At consultation, you should have a very frank discussion with your surgeon as to what you want to have and how likely it is that your desires can be achieved.  It is important to have computer imaging, so that you can both look at the proposed changes and have a "meeting of the minds."

I am anticipating that you will have an excellent result because you have excellent facial features and this augers well for your satisfaction.

Robert Kotler, MD, FACS
Facial Plastic Surgeon
Author, SECRETS OF A BEVERLY HILLS COSMETIC SURGEON
Author, THE ESSENTIAL COSMETIC SURGERY COMPANION

You can have the nose you want as long as you and your surgeon agree to it. In my opinion, your drooping nasal tip can and should raised, creating the supratip break, the clear border between the dorsum of the nose and the tip. But doing so will not make the hump go away. Although it could be masked nicely with a filler for a time ("Nonsurgical Nose job"), as long as you are improving your nose why not address all its deformities? Again, it's up to you.

From your photos I would recommend you consider a type of rhinoplasty. Minor attention to the hump is needed.