Insecure about nose tip, what do you think? (Photos)

Hello and thank you for your question. It sounds like your biggest concern is your nasal tip, which is a little bulbous and drooping, as you mentioned. Addressing the shape of the nose (particularly the nasal tip) is one of the most common reasons people seek out and undergo a rhinoplasty. Many people complain that their nasal tip is too "bulbous" or "boxy" or just poorly defined, and that they would like their nose to be smaller, cuter, more defined, or more feminine. An open septorhinoplasty can best address the entire nose, and is particularly effective for addressing the tip shape and size.
In addition to addressing your aesthetic concerns, your septal cartilage would be harvested (removed) and turned into multiple cartilage grafts, which would then be secured into different areas of your nose for structural support, including in the columella (middle bottom portion of your nose between your nostrils) to really reinforce the tip and prevent recurrence of the drooping.
The open approach is very effective in facilitating complex, precise maneuvers to refine the nasal shape and size to a particular aesthetic and look. Rhinoplasty is arguably the most difficult procedure to perform in all of plastic surgery. That said, I would recommend only going to see a surgeon who feels very comfortable with both primary and revision rhinoplasty procedures, and who has significant training and experience in these types of surgeries. This is a surgery of millimeters, so if the surgeon you're going to only does 1-2 per month, you are not going to get the best result possible.
Regarding the anesthesia, my personal preference is similar to most- full general anesthesia to assure the most controlled environment and facilitate the best possible aesthetic results for such a complex procedure. Everything ultimately comes down to surgeon and patient preference, so always have the conversation with your surgeon so you both know exactly what to expect, and so you both feel comfortable with how the procedure will be performed prior to proceeding.
Of course it is always difficult to provide tentative surgical recommendations, as there is only so much information to be gained from the photos and description provided. I recommend for you to come see me or another plastic surgeon comfortable with rhinoplasty procedures for a formal consultation to thoroughly discuss your surgical goals, undergo a formal examination, evaluate all your options (surgical and nonsurgical), and decide on the best procedure(s) and type of anesthesia for your specific case. I hope this helps!
Best wishes,
Dr. Donald Groves
Plastic Surgeon

Hello! Thank you for your question.
If you can provide photos with better lighting, from the side of your face and 1 meter away I would be able to make a proper evaluation. It would be more convenient to decide with face-to-face consultation. Best regards!

The tip of the nose has two cartilages, on the left and right. It appears that yours are strong and broad, so they make the tip of the nose look wide, and you can almost see their outline under the skin. The woman in the before and after that I posted with this answer had a similar situation, though hers were larger than yours. Those two cartilages are also responsible for holding the tip of the nose *down*, so, like in her before photo, they make the nose look longer than it needs to look. You didn't post a profile view, but those cartilages also hold the tip of the nose out forward away from the face, and adjusting them can bring the nose back closer to the face.
How *much* to narrow the tip, or elevate the tip, 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 work on those tip cartilages -- require advanced techniques, and skill that most plastic surgeons don't possess with expertise. For most noses, it's much better to not have surgery than to have inexpertly-performed surgery. Read my essay on how to stay out of trouble while selecting a rhinoplasty surgeon. And it also discusses how to take photos that are best for online evaluations.