Can the tip of my nose be reduced with closed surgery? (photos)

The tip of my nose is quite square in shape and as a result makes my nose look further out from my face. Is it possible to reshape the tip of my nose with closed surgery? If not, what procedure would I most likely get to achieve a more slim, defined nasal tip? Also, the right side of the tip is larger than the left, causing it to look uneven.

Doctor Answers 13

Closed rhinoplasty candidate, some advices:

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Thank you very much for sharing your concerns with us.

The harmony between facial parts makes us instinctively recognize the beauty... without knowing it, without defining it, just a perception that surprises and captivates us.

In this regard, I suggest perform a Closed Rhinoplasty (without visible scars) to treat the tip, base and nasal bridge.
With this procedure you get a delicate nose, better harmonize with your other facial features.

Dr. Emmanuel Mallol Cotes.-

Dominican Republic Plastic Surgeon
4.7 out of 5 stars 366 reviews

Square Tip (Box Tip Deformity) - Open Or Closed Approach

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It is entirely possible to get a great result from a closed rhinoplasty to repair your nose tip, which is called a "Box Tip Deformity." Do not worry; this term does not mean you are deformed:  it means that the cartilage at the tip of your nose creates a square, boxy shape.  Please do your research well and choose a board certified plastic surgeon with years of experience in rhinoplasty surgery.

Open or closed tip rhinoplasty?

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You appear to be a good candidate for nasal tip surgery but should also consider additional refinement of your bridge to match your new tip.  Being experienced and the use of both open and closed rhinoplasty I would lean toward the open approach using a stair-step incision that I find heals nearly invisibly with consistency. Meet with a board-certified plastic surgeon or facial plastic surgeon to review photographs and discuss your many options.  Best wishes and good luck. Jon A Perlman M.D., FACS
Diplomate, American Board of Plastic Surgery
Member, American Society for Aesthetic Plastic Surgery (ASAPS)
ABC-TV Extreme Makeover Surgeon
Beverly Hills, California

Jon A. Perlman, MD
Beverly Hills Plastic Surgeon
5.0 out of 5 stars 32 reviews

Tip reduction technique

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While I am not so sure that you are a candidate for just tip surgery. When the tip is operated on, there are changes in relation of the bridge to the tip, making other adjustments needed. You shouldn't tie the surgeon's hands. You'll  get your best answers at a consultation,My preliminary recommendation would be for a full, closed rhinoplasty.

Dennis Barek, MD (retired)
Great Neck Plastic Surgeon

Tip reduction with closed rhinoplasty

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Thank you for your question and photographs.I would recommend scheduling a consultation with a board certified plastic surgeon who specializes in rhinoplasty, that way they can perform a physical examination of your nose and give you the optimal results you desire. From what I can tell from your photographs, it appears your tip is enlarged and bulbous. You would benefit from a tip rhinoplasty which includes trimming the lower lateral cartilages and placing precision sutures to refine the tip and make it look more pleasing. These incisions can be made discretely on the inside of the nose if an open rhinoplasty is out of the question for you. 
I would encourage you to submit frontal photos.
Best of luck in your endeavors!

James Fernau, MD, FACS
Board Certified ENT
Board Certified Plastic Surgeon
Member of ASPS, ASAPS, ISAPS, The Rhinoplasty Society, AAFPRS, OTO/HNS, ASLMS

James Fernau, MD, FACS
Pittsburgh Plastic Surgeon
4.9 out of 5 stars 86 reviews

Closed rhinoplasty approach for bulbous tip reduction

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Yes, a closed rhinoplasty approach can accomplish reduction of the bulbous and asymmetric tip, with all the incisions placed on the inside of the nose. The entire nose will need to be performed which will include shaving down the dorsal hump, decreasing the projection of the nose, and narrowing the bridge line. Closed  rhinoplasty is a difficult endeavor,  so choose your surgeon very wisely. Digital computer imaging performed at the office setting would also be helpful to understand what can and cannot be accomplished with the procedure. For more information and many before-and-after results of closed rhinoplasty, please see the link and the video below 

William Portuese, MD
Seattle Facial Plastic Surgeon
4.8 out of 5 stars 157 reviews

Can the tip of my nose be reduced with closed surgery?

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Improving the nasal tip 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. 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. 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 very limited 2 dimensional 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 (ENT) that you trust and are comfortable with. You should discuss your concerns with that surgeon in person.

Robert Singer, MD FACS

La Jolla,California

Robert Singer, MD
La Jolla Plastic Surgeon
4.6 out of 5 stars 22 reviews

Closed vs Open

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An in-person exam and consultation would be necessary for a definitive answer. In general, Done well, either approach could be appropriate. In tip surgery, especially with asymmetry, most surgeons would agree that there is more predictability/control over results with an open approach -PROVIDED IT IS DONE SKILLFULLY.Whatever technique will provide the most predictable/best result in your surgeon's hands is the "correct" answer.

Tip refinement

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Rather than focusing on the approach (open vs. closed) utilized, one should focus on the results of a given surgeon. Tip refinement is possible via an endonasal (closed) approach although most surgeons favor the external (open) approach for that for very good reasons including longevity and predictability of the results. The tiny incision at the bottom of the nose heals extremely well that the scar is essentially imperceptible once healed. The overall result is way more important than the tiny scar at the bottom that nobody can see. Best wishes!

Thomas J. Walker, MD
Atlanta Facial Plastic Surgeon
5.0 out of 5 stars 29 reviews

Tip Refinement Via Closed Rhinoplasty

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Thank you for your question.  Yes, tip refinement is possible thru a closed approach but in most surgeons experience does not give the most predictable results.  Most rhinoplasty surgeons will tell you that an open approach would be best for your situation because it is assymetric.  Try to find a rhinoplasty surgeon that does do many closed tip rhinoplasties.  I do a lot of closed rhinoplasty but if the tip is your main concern, I would recommend the open approach.  Good luck.

Paul E. Goco, MD
Nashville Facial Plastic Surgeon
4.5 out of 5 stars 8 reviews

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.