Reducing an Over-Projecting Tip ("Pinocchio Nose")

My doctor has suggested 2 ways to reduce the over projecting tip. 1 way would be to remove a piece from the columella to pull down the over projecting tip. But wouldn't this a) cause my nortils to flare? and b)change the prientation of the direction the tip is pointing in? The other way was to add a piece of cartlidge to the top of my nose between the bridge and tip to reduce the tip inclination. I think my nose already projects too far off my face so I wasn't too fond of that one.

Doctor Answers 6

Tip Projection in rhinoplasty

Dear Elle,

Your surgeon is right about the 2 different ways to address projection.  If he/she has computer morphing software, you can be shown what you what your nose would look like using both kinds of techniques.  It is best to see this on profile view. 

Ideally tip projection is about the same length as the distance between the base of the nose and the upper lip.  I cannot tell exactly from your photo which you would need, unless there was a profile view.


Nima Shemirani

Beverly Hills Facial Plastic Surgeon
4.9 out of 5 stars 74 reviews

Tip rhinoplasty

The angle of the photo does not allow assessment of your current condition. In order to view tip projection you need a complete side view. Your photo looks down obliquely from the upper left. The desired tip projection is considered to be 2/3 of the length of the nose which in turn is 2/3 of the length of the middle third of the face. The amount that it projects past this is the amount/length of cartilage that is removed from strips of cartilage in the strip of skin between the nostrils to achieve this goal. If it does not project past the 2/3 limit something other than removal of this cartilage should be done. This cartilage is part of the C-shaped cartilages in the tip of the nose. In my experience this does not cause nasal flaring or collapse because the surgery is done on the part of the C near the midline not on the middle or outer part of the C.

My response to your question/post does not represent formal medical advice or constitute a doctor patient relationship. You need to consult with i.e. personally see a board certified plastic surgeon in order to receive a formal evaluation and develop a doctor patient relationship.

Aaron Stone, MD
Los Angeles Plastic Surgeon
5.0 out of 5 stars 1 review

Nasal Tip refinement

Thank you for your inquiry!

It seems that you are a good candidate for a tip refinement and your surgeon provided you with 2 viable options. There is no right or wrong way to go about it but more like the technique the surgeon is more comfortable with to deliver the best results possible. The main goal is to improve the way your nose looks to complement your facial features in a natural fashion. However, without a physical examination it is not possible to provide you with specific details. I highly recommend that you schedule a consultation with a well-experienced surgeon.

It is important to mention that the finest cosmetic results in any particular case are based on a variety of factors, including: the unique anatomy of the patient, realistic expectations, a well-informed and detailed discussion with your plastic surgeon concerning the best options for you especially covering a deep understanding of the pros and cons of any given choice you will adopt.

Please keep in mind that following the advice from a surgeon online who offers to tell you what to do without a physical examination covering the nature and the status of the tissue, assessing your desired outcome, taking a full medical history, and discussing the pros and cons of each operative solution would not be in your best interest. With that in mind, it is the safest and for your best interest to find a plastic surgeon with solid experience and certified by the American Board of Plastic Surgery who is ideally a member of the American Society of Plastic Surgeons that you will trust and be comfortable with. You should discuss your concerns with that surgeon in person.

Good luck!!!

Ali Sajjadian, MD FACS

Ali Sajjadian, MD, FACS
Orange County Plastic Surgeon
5.0 out of 5 stars 195 reviews

Pinocchio nose

I prefer the former technique.  A tip rhinoplasty to refine your tip and reduce the caudal septum to limit the projection of the tip would result in a natural improvement.  Nasal flaring shouldn't be a concern.  Your dorsum looks nice and augmentation may not be the look you want.  Best wishes!

John Michael Thomassen, MD
Fort Lauderdale Plastic Surgeon
4.9 out of 5 stars 49 reviews

Reducing an Over-Projecting Tip ("Pinocchio Nose")

I usually reduce the nasal dome to a level just a few mm above the dorsum and then reconstruct a new dome. No cartilage is added to the dorsum and no flarring of the nostrils.

Mohsen Tavoussi, MD, DO
Orange County Facial Plastic Surgeon
4.6 out of 5 stars 12 reviews

Reducing an over projecting nasal tip

There are multiple ways to reduce an overprojecting tip of the nose.  This involves reducing the anterior projection of the lower lateral cartilages, the dorsal septal cartilage, and potentially even augmenting slight ski slope that is present.  Please refer to the link below and look under the rhinoplasty photo gallery, patient #6.  

William Portuese, MD
Seattle Facial Plastic Surgeon
4.8 out of 5 stars 143 reviews

These answers are for educational purposes and should not be relied upon as a substitute for medical advice you may receive from your physician. If you have a medical emergency, please call 911. These answers do not constitute or initiate a patient/doctor relationship.