I want a more projected tip and less nostril show. Can I achieve that in a revision rhinoplasty? (Photo)

Question

I'm a 26 Caucasian female; originally from Lebanon. I had a rhinoplasty 3 years ago. My nose is now too short with too much nostril show and the bridge is much wider than before. My tip also lacks projection and my nose flares too much when I smile. I attached some photos of my nose after the surgery. I just want a little more length to my nose, a less nostril show, and most importantly a more projected tip. Can I achieve that in a revision rhinoplasty? What are my options? Thank you!

Afshin Parhiscar, MD · Answer

Dear sadeem10De-rotating a nasal tip with correction of alar retraction are challenging procedures for any rhinoplasty surgeon. Although improvement is likely, for  a great result, you need to take your time and find a rhinoplasty expert. You will likely have adequate cartilage for grafting from your septum. In my hands, you would need a series of grafts to both project and extend your tip and alar grafts to correct your alar shape. Your tip definition will be limited by the thickness of your nasal skin. Mediterranean tips are often slightly sebaceous and wont achieve the type of definition that you see in certain Caucasian noses.Take your time and find the right surgeon so you can make an informed decision and get the results that you want.

Thomas A. Lamperti, MD · Answer

I do get a sense of your shortened, under-projected nose from your photos. Revision rhinoplasty techniques are available to address these concerns and add some length and projection to your tip.Ultimately, an in office nasal examination would be needed to formulate a more specific plan and get a better idea of things in your case. In the meantime you can read more about treating nasal under-projection at my web reference link  below.

John Layke, DO, FACS · Answer

After reviewing your photos, it appears that you need tip support and derotation of the nose.  This is easily accomplished using cartilage grafts and other maneuvers that will leave you with a more aesthetically-pleasing nose.  I recommend seeking out a Board-Certified plastic or facial surgeon who will accurately assess your nose, create a simulation which will show you what your nose COULD look like after surgery, and formulate a plan tailored to your needs.  Good luck!

Sam Naficy, MD, FACS · Answer

Based on your photos it appears that you have lost tip support and tip projection.  These can be rebuilt using cartilage grafting such as in the example on the link below.

Tom D. Wang, MD, FACS · Answer

It appears you will need increased tip projection and perhaps lengthening and raising the bridge of your nose to better match the new profile.  It is certainly possible to achieve this via a revision rhinoplasty procedure using cartilage grafting, likely via an external rhinoplasty approach.  Best of luck in your revision!

William Portuese, MD · Answer

Revision rhinoplasty can accomplish adding more projection to the  lower lateral cartilages of the nasal tip with suture techniques and advanced cartilage grafting techniques applied to them. The nostril show can be reduced with a combination of composite skin grafts and a columellar-plasty. Thick skin will be an impediment to seeing a very refined result of the tip of the nose.

David F. LaPatka, MD (retired) · Answer

It is difficult to give an accurate analysis with the photos presented but it appears that you may have an inadequate projecting nose. A properly sculpted shield graft may be the answer . A true lateral photo would not only allow for evaluation of tip projection but also the " nasolabial angle " to be measured to give you a more complete evaluation . A consult with an experienced rhinoplastic surgeon with imaging is highly recommended .
Best

Richard W. Fleming, MD (retired) · Answer

This can be achieved, probably using cartilage grafts, with a revision rhinoplasty, Consult with a rhinoplasty specialist who specializes in revision work.

Francis R. Palmer, III, MD (retired) · Answer

From the attache photos that should be achievable with a revision Rhinoplasty that could address these issues.  Hope this helps.

I want a more projected tip and less nostril show. Can I achieve that in a revision rhinoplasty? (Photo)

Answers (9)

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