Rhinoplasty or Tip Plasty? Hard decision.

Question

Hello. I am having some difficulty deciding if I should go ahead with a Rhinoplasty or only Tip plasty. A surgeon told me both can be achieved but obviously a Rhinoplasty will give me better results. I have a small bump that surgeon said it can be shaved if going ahead with Tip Plasty. I have included photos. Any advise please? I can't decide. Thank you.

Arturo Valdez, MD · Answer

Hi maric33

Thank you for your question.
For your specific case, we can see in the front-facing photo that you have a deviated septum, so right away we know that you would benefit most from what's called a Rhinoseptoplasty. This will correct the deviation and not only be an aesthetic improvement but, also a physical improvement which, may improve your breathing as well. Ethnicity also plays a role, is the bulbous tip of your nose caused by the cartilage? or, just thicker skin and tissue? 
A physical consultation would be best to determine what is causing the bulbous tip but, definitely, a Rhinoseptoplasty is recommended for your situation and, the surgeon could then determine the best course of treatment for improving the tip while he is correcting the deviated septum. 
I hope this has helped and I wish you the best!

Suleyman Tas, MD, FEBOPRAS · Answer

Hello maric33,

Thanks for your question. Based on the limited pictures I recommend you undergoing a full rhinoplasty, as you have a challenging deviation starting from your radix. Straightening this type of deviation requires expertise and precise approach. You may also benefit from eliminating your hump and reduction of the tip with a Closed Technique- endoscopic appoach. For more before and after pictures please click the link below.

Kind Regards

Eric M. Joseph, MD · Answer

After your bump is removed, you would likely require osteotomies to narrow your nose. When bridge work and tip work are combined, tip-plasty becomes rhinoplasty. Hope this helps you! Dr Joseph

Jonathan Kulbersh, MD · Answer

Thank you for your question and photos. While a tip plasty would offer some improvement, it would not address the crooked bridge or the small dorsal hump you have. I recommend a full rhinoplasty that would address all concerns at one time and give you the most natural result. Make sure you are working with a very experienced, board-certified facial plastic surgeon with expertise in rhinoplasty techniques to ensure the best possible results.

Gerald Minniti, MD, FACS · Answer

Although you may not notice or care now, not addressing your septal deviation, which is contributing to some external asymmetries, you will likely notice after a simple tip plasty and possibly be dissatisfied. Your nose deviates to one side, and your nostrils and tip do as well. This can only be fixed by addressing the septum, which is by definition a rhinoplasty.

Nima Shemirani, MD · Answer

Dear maric33,
You should have a full rhinoplasty because the nose is crooked from the frontal view as well.  It will be difficult to address just the tip and will look off if you do not fix the rest of the nose.

I wish you the best!
Sincerely,
Dr. Nima

Paul E. Chasan, MD, FACS · Answer

Thank you for your question. You are an excellent candidate for rhinoplasty, but not a tip rhinoplasty.  Very few noses can be improved with just a tip plasty.  I think it is one of the most beautifying surgeries that we do as plastic surgeons.  A large portion of my practice is dedicated to rhinoplasty surgery.  It is important to only see plastic surgeons with extensive experience in rhinoplasty, ie perform at least 6 per month and have performed hundreds of cases. Also, critically evaluate on-line galleries to see if their art form resonates with yours. Rhinoplasty is definitely a grey haired plastic surgeon's sport. Best wishes to you.

Ronald J. Edelson, MD · Answer

Thank you for the question. Don’t do just the tip only. Your nose needs a full rhinoplasty including lowering the bridge a fair amount and narrowing the nose. Your nose projects too far and just doing the tip won’t give you a good result

Robert Ciardullo, MD · Answer

Rhinoplasty or tip plasty: A tip plasty will make the tip slightly thinner and may slightly deproject the tip. Your whole nose is slightly over projecting and you do have a small bump. if you do just a tip plasty you may make the over projection of the rest of the nose and the small hump appear larger in proportion to the smaller tip. Simply rasping the dorsum without in fracturing the bones may result in a wide flat looking bridge. If you want the nicest nose including the nicest possible profile, a rhinoplasty in my opinion would do a much better job than a limited tip plasty. But how much improvement you are seeking is ultimately up to your own taste.

Robert Singer, MD · Answer

Improving the nasal tip to achieve an improved natural appearing cosmetic result is a frequent request of patients wanting nasal refinement. It is possible to improve the cosmetic appearance of the tip alone without altering the rest of the nose in some patients, but a better cosmetic result would be achieved with a natutal appearing rhinoplasty. Whether the optimal option in your particular situation would be a tip rhinoplasty alone or a full rhinoplasty would best be determined at a consultation. It is an individual decision. Either procedure can be performed with a closed or open approach.

Following the advice from a surgeon on this or any other website who proposes to tell you exactly what to do based on limited photos without examining you, physically feeling the tissue, assessing your desired outcome, taking a full medical history, and discussing the pros and cons of the operative procedure would not be in your best interest. I would suggest you find a plastic surgeon with extensive nasal surgery experience who is certified by the American Board of Plastic Surgery and ideally a member of the American Society for Aesthetic Plastic Surgery (ASAPS) or a facial plastic surgeon (otolaryngologist) that you trust and are comfortable with. You should discuss your concerns with that surgeon in person.