Minor Tip Plasty w/ sutures alone under local?

Question

The thing that bothers me most about my nose is my ill-defined tip. I had a consultation with a doctor who said tip plasty alone would be feasible. During my research, I encountered this article: Interdomal Suture through a Nondelivery Endonasal Approach: A New Technique by Harel and Leibou It made me wonder: would it be possible to have interdomal sutures places under local anesthesia to make a minor, less invasive change to my wide nasal tip? Could this be done as a stand-alone procedure?

Richard G. Reish, MD, FACS · Answer

Hello and thank you for your question.  The best advice you can receive is from an in-person consultation.  It is extremely difficult to give specific advice about nasal tip surgery without evaluating your tip.  Make sure you specifically look at before and after
pictures of real patients who have had this surgery performed by your surgeon
and not just a computer animation system. 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 person.
Best wishes and good luck.
Richard G. Reish, M.D.
Harvard-trained plastic surgeon

Michael Dobryansky, MD, FACS · Answer

Tip work represents some of the most intricate portions of the rhinoplasty surgery. As such, it is not simple and should be done under the most ideal circumstances. I would advise against attempting it under local anesthesia.

Keith M. Blechman, MD · Answer

Rhinoplasty is complicated and when making an adjustment on one part of the nose, it's frequently necessary to subtly address another area in order to maintain aesthetic harmony.  The more difficult it is for the surgeon to access and visualize all the structures of the nose, the more challenging it is to deliver a good result.  Of course, any approach can be attempted, whether under local or not, but even with skilled hands, the more limited the surgical exposure (i.e. minimally invasive), the more complicated the seamless execution of the rhinoplasty.A visit to a plastic surgeon's office will help you to understand if you're a candidate for the procedure, and what aesthetic outcomes are realistic in your particular case.  In order to get a qualified, ethical, and expert opinion on your surgical options and expectations, schedule an in-person office consultation with a plastic surgeon certified by the American Board of Plastic Surgery.
Best of luck,
Keith M. Blechman, MD
New York, NY

Philip S. Schoenfeld, MD, FACS · Answer

I frequently see patients for a second consultation or following a previous rhinoplasty who tell me about the extremely non invasive way that another physician has described to them how they are going to fix their nose.   I feel that your first concern should be an excellent surgical outcome that you are confident with and one that will last and you will enjoy for many years.  Choosing a surgeon for your rhinoplasty procedure based on the promise of "minimally invasive" rhinoplasty and minimal downtime does not guarantee that your goals will be met.  As the patient you have complete control (within reason) over how you would like your nose to look.  The surgeon should perform the appropriate surgery based on their experience in order to deliver you the nose you desire.

Reza Momeni, MD, FACS · Answer

for select patients who are not anxious and can handle local anesthesia procedures, we have done tip-plashy nose work (and more) in our offices without problems.  Be sure to discuss your goals and concerns with your board certified plastic surgeon and consider the pros and the cons. Be certain your surgeon is properly certified.  I've attached a link where you can start your search.

Steven Wallach, MD · Answer

Best to be seen in person to determine what might be best for you. Sutures in the tip cartilages can be placed through a closed approach using a delivery technique, but I prefer doing it open without distorting the two cartilages' normal relationship.

William B. Rosenblatt, MD · Answer

This can be a stand alone procedure, but dont think that any new un proven technique is the best. You would not be happy doing this under straight local. We do intra domal sutures under sedation with a delivery technique that is tried and true.

William Portuese, MD · Answer

First of all, a tip- plasty is not a minor procedure and any type of sutures affect the nose in a three-dimensional fashion. It's also very painful to try to undergo any type of rhinoplasty under local anesthesia since it is very painful to get the nose numb and most patients can't tolerate that. Trying to perform rhinoplasty under local anesthesia is simply a very bad idea... In addition, most patients must undergo a full rhinoplasty in order to make sure that all the components of the nose balance with themselves, and the new nose balances with patient facial features. A full set of facial photographs and in-person examination required talk about the appropriate surgical techniques to make the required changes to the nose. For more information and many examples, please see the link below to our Endonasal  rhinoplasty photo gallery

Shervin Naderi, MD, FACS · Answer

So the short answer is no.  The long answer is definition almost never comes from one or two sutures be it under local or general anesthesia or through closed or open technique.  There is much more to it than that in the vast majority of people.  Without your pictures it is not possible for me to give you more specific recommendations but I suggest you find the best possible surgeon and let him guide you since he will be able to see and examine you.  Closed suture techniques without use of grafts usually in many people result in a pinched appearance with retraction of the nostrils.

Jon Ver Halen, MD, FACS (license suspended) · Answer

Hello and thank you for your excellent question. There are many types of rhinoplasty that can be performed under local anesthesia, and/or conscious sedation. Of course, you will need an in-person consultation to evaluate you for this procedure. Preoperative visualization and surgical simulation with the Crisalix system may help with your decision. Any treatment plan should be based on a detailed discussion with equal input from both you and your surgeon. Make sure you specifically look at before and after pictures of real patients who have had this surgery performed by your surgeon and evaluate their results. The most important aspect is to find a surgeon you are comfortable with. I recommend that you seek consultation in person with a qualified board-certified plastic surgeon. Good luck!

Best,
Jon Ver Halen, MD FACS

Harvard educated plastic surgeon

Best,
Jon Ver Halen, MD FACS

Harvard educated plastic surgeon

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