Osteotomy and Tiplasty - supportive enough? (photos)

Question

I'm a southeast asian woman with thick skin. I'm looking for a subtle change to alter the frontal view. I have wide nasal bones and a bulbous tip. I was told by one doctor an osteotomy and tiplasty - ear cartilage will suffice. However, another doctor said that there needs to be dorsal augmentation to support the tip. Is this accurate? I do not want a synthetic object on my bridge and am scared that rib rhinoplasty may be too much of a drastic change. My question is will tiplasty drop overtime?

Zoran Potparic, MD · Answer

Tip surgery and lateral osteotomies are definitely needed in your case. However, whether dorsal augmentation is needed and to a what extent, may be decided only on the basis of in person consultation, discussion about your goals and, if available, 3D simulation. A third consult with a true expert in rhinoplasty may help. Good luck.

Nima Shemirani, MD · Answer

Hi @lglarracas. You are an excellent candidate for a primary rhinoplasty. Cartilage grafting and nasal bridge augmentation may be required to achieve your desired outcome. I recommend seeing an expert  rhinoplasty specialist for an in person examination. There are several options for you that can be determined after examination. In my practice, I utilize piezosurgery. Piezosurgery is a more gentle technique that allows for greater precision. Less bruising and swelling is common with Piezosurgery. In a typical rhinoplasty, a hammer and chisel technique is performed leading to more inadvertent fractures. Best of luck, Dr. Nima!

Jonathan Kulbersh, MD · Answer

Thank you for your question and for providing photos. This skin, wide nostrils, and a bulbous tip are common features of Asian noses, along with a weak bridge or dorsum. For this reason, cartilage grafting and nasal bridge augmentation may be required to achieve the desired result. Keep in mind that rhinoplasty is one of the most complex of all plastic surgery procedures, requiring experience, skill, and even artistry to achieve an optimal outcome. I recommend scheduling an in-person consultation with an experienced, board-certified facial plastic surgeon, with expertise in rhinoplasty techniques, as well as ethnic rhinoplasty. They will be able to answer any questions you may have and explain the techniques they plan on using during your procedure.

Celal Alioglu, MD · Answer

Hello you need to use cartilage to up your projection on your nose and a little up your nose tip....

Cem Berkay Sinaci, MD · Answer

Hello. Thick skin asian noses definitely need a tight support for the tip even for a subtle change. That may be based on septum or columella, with a piece of resistant cartilage. Ear cartilage is not strong enough for tip support especially in thick skinned patients. I highly recommend and do rib cartilage graft which lengthens the operation time for about 30-45 minutes, and leaves a scar about 3 cm hidden in the breast fold. You may think thats too much of a drastic change but even for a minimum change on thick skin patients that is usually needed.

Osteotomy and Tiplasty - supportive enough? (photos)

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