What Would You Recommend for an Asian Bulbous Tip and Wide Alars? What can I do to fix the tip? (photo)
Doctor Answers 11
Rhinoplasty for the Asian nose.
Your bridge can be narrowed and your tip refined. Your profile is good unless you want a little more projection, but only slight. You do Not need nostril narrowing and the base of your nostril is vertical already.
You have a thick nasal tip and there is not enough projection of the tip. You would benefit from reduction of the fat in the nasal tip and reduction of the width of the lower lateral cartilages. In addition you would benefit from plication of the lower lateral cartilages to enhance projection in conjunction with a columellar strut graft.
Bulbous tip in the Asian nose
Given your age and what I think is a decent looking nasal bridge (not much if any need for augmentation) I would limit your rhinoplasty to nasal tip refinement without any tip projection and minimal if any superior rotation. Here's a break down of what and why:
1. Your projection is pretty good, and your tip is not terribly under rotated. Refine the tip by doing a concervative excision or your lower lateral cartilage. Your surgeon will call this a "cephalic trim." Keep in concervative. In the first month you may look at it and think, "I don't see it." Wait until the third or forth month. Then you will see it. You can always take a little more later. I takes a lot of work to restore cartilage if too much is taken.
2. The cephalic trim will refine the tip but if a bit more is needed you can have some suture techniques performed to make the tip a bit sharper. This can project the tip a bit so do it carefully.
3. To an internal alar base reduction. This will make the base width of your nose a bit more narrow and at the same time give the entire nose a sleeker, more narrow look. Do this conservatively as well.
Try to find someone who works on the Asian face regularly. Might want to check out New York if you're in New Jersey.
Hope that helped. Last thing, when I mentioned your age and keeping it concervative. The changes you make now will me augmented when you're 30, 40 and so on as the skin envelope around your nasal bone and cartilage thins a little. Aggressive surgery looks bad as you age.
Best of luck
Chase Lay, MD
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I think the alarplasty is fine but the final results of the tip will be limited due to the thick skin there. In many cases the only way to achi ve the appearance of a more defined tip is to place cartilage grafts to push on the skin and give the illusion of the skin being thinner, but this will also make the tip longer.
Asian noses with thick skin can be refined by rhinoplasty
The main principle for treating Asian noses with thick skin is the opposite of standard "Western" rhinoplasty techniques. Thick skin is usually associated with weak cartilages. The way we make the tip more refined is to use grafts of your own cartilage in the tip called strut and shield grafts to push into the thick skin and create definition. This is sometimes accompanied by narrowing the nostils (alarplasty) and also occasionally adding to the upper part of the nose just below the eyes, called the radix.
Asian rhinoplasty might need tip support
Rhinoplasty for Asian skin type and features will often require support to improve teh tip projection and force tip definition. Visible tip cartilage grafts can narrow, support and refine your tip. Computer imaging can help you try out changes to see what will give a best look for you.
Best of luck, peterejohnsonmd.com
Nasal tip surgery for an Asian nose
Your nasal skin appears to be thickened. This will definitely effect your final result. The nasal cartilages can be reshaped and the fibrofatty pad under the nasal tip skin can be thinned. You may require a columellar strut graft to give more projection to the nasal tip.
Well-performed Rhinoplasty Surgery may be employed to narrow your tip and nostrils.
I read your concerns and reviewed your photos. Your tip is a bit underprojected which accentuates the flat broad appearance of the lower third of your nose. You may benefit from tip narrowing, nostril narrowing, and structural tip support (columella-strut and possible tip graft), for a pleasing aesthetic result. These grafts may improve the appearance of your retracted columella as well.
Hope this is helpful for you.
Read This - no alar wedge!!!!
You need-1) columellar strut. 2) alar cinch 3) thinning of nasal skin 4) possible dorsal on-lay graft (single graft vs diced cartilage 5) - finally, infracturing. See cases of this approach at rhinoplastyboston.com
alar wedges (weir excision) does nothing to narrow
the lower third of the nose, and leaves a pinched "done" look.
What Would You Recommend for an Asian Bulbous Tip and Wide Alars?
The thickness of your tip will require tip defatting and cartilage grafts. Once your tip is refined, the alar width will look less wide however still may require reduction. See link below to read about reduction of bulbous tips.