Is it possible to trim pointier side of tip in a small revision? (Photos)

Question

10 months post-op, my nose looks very wonky and although my nostrils look even from the bottom, on front view they look completely different and I think it’s due to one side of my tip being higher and pointier. When I push it down the nostrils even out, what can be done to fix this issue? My surgeon hasn’t responded to me in a month so I would like to ask for advice here.

Gregory S. Dibelius, MD · Answer

In cases where there is a "pointiness" on one side of the tip associated with a different nostril shape, I would guess that the underlying issue may be an asymmetry of the tip cartilages. This theory is supported by the fact that if you push down on the pointy side it helps fix the nostril issue. One slight caveat is that at 10 months out there is still some swelling reduction that needs to occur, although it is a decent time point to make an assessment. 
However, I want to make the point that in most cases I would avoid doing a minor procedure to trim down the pointy part of the tip. The tip cartilage that runs on that side is a continuous piece that goes from out laterally near the cheek, then making a sharp curve at the pointy part of tip as it goes down into the middle columella area. Because of this, trimming the middle dome portion might actually make things worse, turning a small problem into a bigger problem. Although it may reduce the "pointiness", it may damage the integrity of that cartilage and make the nostrils more uneven, as the cartilage becomes weakened by the procedure. There is one situation that I can think of where it might be ok to attempt a minor procedure, and that is if the bump is actually a graft that has not healed in quite the right spot. Only your surgeon is going to know if that is the case, so I would continue to try and reach out to them. 
In summary, I would encourage you to get in touch with your surgeon or to seek out a second opinion consultation to help you make a decision on this. But I would strongly recommend that you avoid doing any potentially destructive procedures until you have a clear plan for your nose.

Onur Gilleard, MBBS, FRCS(Plast) · Answer

Improving nostril asymmetry is one of the hardest aspects of rhinoplasty. Yes you do have a bit of tip asymmetry which contributes to the difference in nostril shape. It may be that some scar tissue has developed in an asymmetrical way or that the tip was slightly asymmetrical after surgery. Regardless, to improve this is not easy. You need to speak with you surgeon to see if revision is the correct decision for you. Personally I think your nose looks good overall from what I can see and I’d lean toward leaving it alone

Is it possible to trim pointier side of tip in a small revision? (Photos)

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Is it possible to trim pointier side of tip in a small revision? (Photos)

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