How Nose Tip Reduction is Done?

In more than 35 years of rhinoplasty I have never had a patient have necrosis. Tip reduction involves what is making the tip large such as cartilage and soft tissue but more importantly not creating a bad result such as pinched tip ,etc. 

          The lower lateral cartilages can be reduced if appropriate.  The cartilage components can be brought closer together with sutures.  The cartilages can be further shaped with sutures.  The fibrofatty layer can be reduced as well.  I typically try to avoid cartilage grafts due to long term problems with tissue thinning and skin compromise as well as visibility and palpability.  I have never observed skin necrosis of any sort.  Find a plastic surgeon with ELITE credentials who performs hundreds of rhinoplasties each year.  Then look at the plastic surgeon's website before and after photo galleries to get a sense of who can deliver the results.  Kenneth Hughes, MD Los Angeles, CA

There are many techniques to change the appearance of the nose. This usually includes combinations of reducing, or removing tissue, as well as changing the existing tissues with sutures, and finally grafts can be added. Typically upper portions of the Lower Lateral cartilages are removed, as well as some fibro-fatty tissue. Skin is not typically removed. Aggressive thing of the undersurface of the skin can be dangerous in an open rhinoplasty and increase your risk of necrosis. This should be a rare event in experienced hands though is more possible in patient who have had a lot of previous nasal surgery, or who are smokers.

A nasal tip rduction can be performed with a series of manuevers to reduce the tip size. Commonly tip sutures into the lower lateral cartilages can refine the tip and sometimes small portions of the lower lateral or even medial crural cartilage are addressed. Other maneuvers of the soft tissue can reduce the overall height as well and be secured with sutures.

Reducing the projection of the tip as accomplished through multiple different techniques including dorsal septal reduction of the hump, nasal spine, and suture techniques to decrease the overall projection of the nose. Cartilage is sometimes removed as well. Please see the link below for videos and diagrams all about rhinoplasty techniques and procedures.

Nasal tip reduction is a common request when discussing rhinoplasty.  There are two paired shaped cartilages as well as a middle cartilage (the septum) that contributes to the shape.  In addition some people have an excess of fibro-fatty tissue at the tip.

Your plastic surgeon will make an assessment of your nose and the shape of each of the cartilages.  It is important to understand what is causing the problem so an adequate plan can be devised.  It is also important to evaluate the airway so measures can be taken to prevent any breathing difficulties when the tip is reduced.  Your surgeon creates a balance between airway needs, the tip shape, and the shape of the dorsum.

If you wish to google the anatomy, the upper cartilages are called the upper laterals and the lower paired cartilages are the alars.  And to answer you question on skin necrosis - the blood supply does not come from the cartilage so necrosis is almost unheard of just because a cartilage is trimmed.  Best of luck to you.

Most often I  reduce the size of the tip by primarily changing the contour of the tip cartilages. I avoid removing a lot of cartilage because I want to maintain the strength and integrity of tip support and not weaken the tip structure. In fact I may add cartilage to provide definition if a patient has a genetically weak tip. In over 35 years I've never seen skin necrosis after tip work.