Is it possible to slim down a nasal tip without the use of a tip graft? Would defatting, cephalic trim, or other be enough?

Question

Bulbous tip with thick skin. Would defatting of the tip, cephalic trim, and/or tip cartilage suture be enough to narrow down and give the tip of the nose a slightly more contoured shape? Not looking for a drastic change, just very very slight and subtle.

Edwin Kwon, MD, FACS · Answer

You can certainly have defatting of the nasal tip skin, cephalic trim, and tip defining sutures, but these may or may not be enough depending on what your native anatomy is like and how much change you are looking for.  Some of the limitations that you will encounter in Asian noses is the skin envelope, which may be too thick to achieve what you're looking for without tip grafts.  Additionally, your lower lateral cartilages may be thin and small, in which case a cephalic trim would not be helpful.
  
Some patients have concerns that their nose tip might feel too firm following tip grafts; I find that utilizing ear cartilage for the tip grafts make it a little softer than utilizing septal or rib cartilage.
  
You should discuss with her surgeon your concerns about tip grafts, and what can realistically be achieved if you choose not to have them in your rhinoplasty.

Donald B. Yoo, MD, FACS · Answer

A rhinoplasty specialist will be able to comprehensively address the issues you have with your nose.One thing to keep in mind though is that there is a limitation to the amount of tip refinement you can achieve (how small/narrow) depending on the thickness of your skin. While there are a variety of approaches and techniques employed by various surgeons, it is up to you to do your due diligence to find a rhinoplasty specialist experienced in Asian rhinoplasty in order to achieve the best results possible. Using autologous grafts (tissue and cartilage from your own body) will provide the safest and most permanent results.Consult with 2-3 of these surgeons in person and determine your comfort level with their approach, demeanor, and before and after results. Good luck.

William Lao, MD · Answer

All the procedures you described can definitely narrow your tip and give your tip a more defined look. But if your nasal skin is really really thick and often times just those changes won't show and you will need some kind of tip graft to enhance it.

Eric M. Joseph, MD · Answer

In general, we utilize extended-shield tip grafts liberally to achieve nasal tip narrowing in Asian patients. This is typically combined with a cephalic trim, columellar strut graft, and sometimes defatting the tip. An examination would be necessary to answer your question, and the decision to place a tip graft is often made in the OR - especially if it makes the nose look better. Hope this helps. Dr Joseph

Toby Mayer, MD · Answer

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Thick nasal skin and thinning it.  The actual skin of the nose cannot be thinned but the muscle and fat and fascia can be removed as well as refinement of the tip cartilage to appear thinner and still achieve a great deal of improvement with a rhinoplasty. See a very experienced rhinoplasty surgeon for this.

Sean Fisher, MD · Answer

The answer to this question is highly dependent on individual anatomy. The thicker the soft tissues, the more difficult it is to enhance tip definition A bulbous tip can be due to cartilage structure, soft tissue thickness or a combination of both. The best technique to use to control this would be determined at the time of surgery and depends on current tip projection and rotation and desired outcome. If changes in tip position are needed, often a septal extension graft is the best strategy to use (especially in thicker skinned patients) as suturing techniques alone or columellar strut grafts may not be strong enough over time to maintain tip position. Often, when additional tip definition is desired, a combination of soft tissue debulking, cephalic trim, tip suturing and septal extension graft are used to reach a final result. 
Sean Fisher Aesthetic Plastic Surgeon

Hong Ryul Jin, MD · Answer

Defatting and cephalic resection can narrow and define your tip a little bit, but it will also decrease your tip projection. Adding a cartilage graft on top will match the original height and has an effect of tip narrowing. If you have a thick dermis, this cartilage graft is usually necessary even though you might want a slight change. In any case, a thorough face to face consultation is a must. Thank you.

William Portuese, MD · Answer

A full set of facial photographs and an in-person examination are going to be required to make a determination about the thickness of the nasal tip cartilages, and the thickness of the nasal tip skin.  There are also many different kinds of cartilage grafts which can be placed in the nose. Much more information is needed.  For many examples of rhinoplasty, please see the video  below

Richard W. Fleming, MD (retired) · Answer

In patients with thick skin there are multiple techniques to decrease width and improve contour and definition. An experienced rhinoplasty specialist will  explain results you will achieve depending on the surgical approach selected.

Is it possible to slim down a nasal tip without the use of a tip graft? Would defatting, cephalic trim, or other be enough?

Answers (9)

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