Rhinoplasty advice. (photos)

My nose is quite angled up already, I have a bulbacous tip of which I want to be reduced but also I have a lot of nostril on show already. The collumella hangs lower than the alar. Advise I've been given is by the doctor I'm swayed to go with is.... Reduce width of nose, reduce the tip, trim the cartlidge that is pushing the collumella downwards and reduce the alar very slightly. Will that result in a piggy nose?. I want a nice soft proportionate nose that will not turn up too much at the tip.

Doctor Answers 6


Hello and thank you for your question. Based on your photograph, you may benefit from a tip refining rhinoplasty. Your surgeon can accomplish this by trimming, suturing, and reshaping the cartilage in your lower nose. Cartilage grafts may also be used to help improve tip refinement. You may also benefit from trimming the caudal septum slightly and the caudal portion of the medial crural footplates the help address your columellar show. The most important aspect is to find a surgeon you are comfortable with. I recommend that you seek consultation with a qualified board-certified plastic surgeon who can evaluate you in person.

Best wishes and good luck.

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

New York Plastic Surgeon
5.0 out of 5 stars 67 reviews

Rhinoplasty candidate

  A closed rhinoplasty approach can accomplish straightening the nose, shaving down the dorsal hump, reducing the projection of the nose, rotating the tip downwards, reducing the bulbous tip, and reducing the hanging columella with all  of the incisions placed on the inside of the nose. It is very important to not turn the tip up. For many examples, please see the link and the video below to our closed rhinoplasty  photo  gallery

William Portuese, MD
Seattle Facial Plastic Surgeon
4.7 out of 5 stars 126 reviews

Rhinoplasty advice.

Hello simply_g - Thanks for your question.  All of the maneuvers your surgeon is suggesting make sense accept for the alar width reduction.  Alar width reduction has the tendency to cause the tip to swing up a bit.  It can still be performed, but it must be done very conservatively or you will look pinched.  On profile view, you already have an increased columellar-labial angle which means you are already starting to tip up.  Bringing the columella up further will increase the chance of a piggy nose.  Your main problem is that you have malposition of your lower lateral cartilages, which make up the bulbous tip.  These cartilages can be repositioned to lower the height of your nostrils while harmonizing your tip to the rest of the nose.  Make sure that your surgeon is a rhinoplasty specialist.Good luck,Dr. Shah

Manish H. Shah, MD, FACS
Denver Plastic Surgeon
4.7 out of 5 stars 45 reviews


Your ala are not wide so I would not recommend an alar base reduction.  Your tip is a bit wide so suturing the domal cartilages together would be good.  From the side your nostril shape is nice without excessive alar retraction or columellar hang so I would not reduce your columellar show.  A slight dorsal reduction would femenize the nose nicely.  Best wishes, Dr. T. 

Outcomes are surgeon dependent

Plan of operation for your rhinoplasty makes sense. Outcome depends on skill of the surgeon.  With an operation that is done well you will not have piggy nose.

Vasdev Rai, MD
Dallas Plastic Surgeon
5.0 out of 5 stars 21 reviews

Rhinoplasty for angled tip

Your nasal tip shape does pose a bit if a challenge for a rhinoplasty in that caution needs to be exercised in making sure that the tip is not turned further upward.  I would suggest a slight relaxing of the columella so that it doesn't appear to 'hang.'  A technique whereby the columella can be set back would allow for the relaxing of the upper lip as well so that it is less obtusely angled and more relaxed (ie the upper lip can be made to appear less "pulled" upward).  Additionally, internally placed incisions with in the nostrils can make them less apparent on the frontal view.   

These answers are for educational purposes and should not be relied upon as a substitute for medical advice you may receive from your physician. If you have a medical emergency, please call 911. These answers do not constitute or initiate a patient/doctor relationship.