Placin some sutures can be done using the closed or open approach. In fact 98% of open techniques can be done closed in my experience. Done sutures are the main intervention used for substantial tip refinement suturing the domes actually helps stabilize and strengthen the tip. Cartilage is not always required but often is used to further strengthen or stabilize the tip to help with longevity and airway support. Rotation and projection are not always the result of tip work. Those aspects can be controlled with the techniques used.
Many rhinoplasty techniques include some form of tip refinement which may include cartilage trimming and suturing of the tip cartilages. Most are done open.
Hello and thank you for your question. Based on your
description, you may benefit from a tip refining rhinoplasty. There are many ways to accomplish this in a natural looking manner.
The most important aspect is
to find a surgeon you are comfortable with. I recommend that you seek consultation
with a qualified board-certified plastic surgeon who can evaluate you in
Best wishes and good luck.
Richard G. Reish, M.D.
Harvard-trained plastic surgeon
The bulbous tip is refined with either a conservative cartilage removal, or suture techniques applied to the lower lateral cartilages of the nasal tip. Both are performed when there is excessive and wide cartilage in the tip. The bulbous tip reduction procedures can be addressed with either closed or open rhinoplasty, depending upon the surgeon's preference. Cartilage grafting techniques are only used when needed. For more information and many examples of bulbous-tip reduction with closed rhinoplasty, please see the link and the video below
Rhinoplasty surgery is really one of the most complex of the major types of cosmetic surgery. The three dimensional structure, the numerous structures involved, the numerous maneuvers possible to combine and even differing ways to achieve same/similar results. Your questions are all questions a good surgeon will be considering as they are evaluating your nose, your goals and their operative plan.
Clearly, you would need an in-person examination and thorough consultation to have a more complete picture of your specific situation.