I had rhinoplasty over a year ago.. He lifted the tip a little but not nearly enough.. And the tip appears to be bulbous. How would you go about fixing this? Shaving? Grafts? Please help
How would you go about removing my droopy tip? (photo)
Doctor Answers 9
Correcting Droopy Tip
Your tip is wide and poorly defined. You nose is long and the tip sagging with a hanging columella secondary to a long septum and possible loss of tip support. After an examination by a nasal revision specialist your alternatives will be explained and your expectations established.
Secondary Rhinoplasty for Tip Elevation and Narrowing
While what your nose looked like beforehand is not shown, there is a lot of room for improvement in tip elevation and some shortening based on these pictures. In simplicity, judicious removal of cartilage that may be blocking the upward rotation and adding cartilage support and sutures to hold it up and back are needed. It is not known what was done initially but I suspect very little of that approach was used based on your current tip shape and position.
Droopy tip - revision rhinoplasty
The three main reasons your tip may be drooping after your rhinoplasty are likely:
-excess length to the medial crura (the lower portion of the tip cartilage)
-excess length of the end of the septum
-improper positioning of the medial crura
To correct this during a revision rhinoplasty, the medial crura may need to be shortened or positioned higher up. Alternatively, the lower portion of the septum may need to be trimmed.
This would be done best via an "open" approach and should be achievable.
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Revision rhinoplasty for a droopy tip etc.
Your tip complex is fallen because it was inadequately supported with your first surgery. The tip needs to be projected and supported so as not to fall into a similar position. It looks like you have a bit of a hump remaining as well needing grafts to the mid nose to open it and your airway and create a much prettier aesthetic result. See a very experienced revision rhinoplasty surgeon for the best result
Droopy tip help
I would trim the caudal septum to allow your columella to retract back . I would perform cephalic trimming of your lower lateral cartilage. I would use septal grafts as a columellar strut to securely hold your tip up and I would suture the entire tip complex up as well. Additionally, I would place a cartilage onlay graft over the left side of your nasal dorsum to improve the concavity that is present currently.
Hope this helps !
Removing a drooping nasal tip
Correcting your nasal tip involves rotation and support and can be successful with a secondary rhinoplasty. We often find that a tip droops because of lack of proper support, but an examination and simulations should sort out the issues.
How would you go about removing my droopy tip?
The caudal septum can be trimmed and the footplates anchored to the remaining septum and the tip can be further reduced with additional trimming and soft tissue modification as well as suture techniques. I would avoid grafts. Also, you may consider tip deprojection as well when the tip is lifted.
Find a plastic surgeon with ELITE credentials who performs hundreds of rhinoplasties and rhinoplasty revisions 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
Thank you for supplying the photos. The 'droopy' tip you are describing is the result of the technique used to refine your nose as well as your tip cartilages innate shape. The ideal angle that the tip of your nose makes with your lip is between 95-105 degrees. Anything less than 90 degrees gives the appearance of a heavy weighed down nose. This relationship in combination with the tip cartilages having a significant downward direction produces a 'droopy' tip. To alleviate this issue, revision rhinoplasty will be required. I would suggest securing the medial crural feet of the tip cartilage to the septal cartilage just behind the tip cartilage with permanent sutures. The tip cartilages may also require some additional sculpting. Best of Luck. This is a very fixable issue.
I like a challenge, and that is what you have! But, it can be done. The first thing I'd say is it is CRUCIAL to know what happened exactly in your last surgery. the more we know, the better the revision will be. It looks like you still have a bit of a bulbous tip for your nose size as your upper nose is narrow and very nice. I believe you have two things (in my opinion) that could be augmented and improved. The first, is a bit of a hanging columella (the part of your nose that separates right from left. Its a bit droopy there as you say. Also, your tip is a bit ptotic (again, medicalese for droopy).
I think you certainly have options and some may work perfectly. One option would simply be what is called a lateral crural overlay with a dome binding suture. (I put this here so you can look it up). this may "pull" your tip up slightly as well as reduce some of the droopiness of your tip (and maby even columella very slightly). The second option, would be to trip some of the cartilage in your columella and re-attach it to your septum to pull it up.
Those are just some options and impossible to know for certain without seeing you in person. But here in Ottawa (canada) we typically see alot of people with similar concerns so I am sure as long as you find a FRCSC certified Facial cosmetic head and neck surgeon in Canada or a Board certified surgeon in the USA, you'll get great advice.