Is It Possible to Have a Tip Plasty to Refine the Tip and Adjust the Columella?

i would like to know if a tip plasty requiring refinement of the tip and/or maybe fixing up the columella to nostril ratio is a less work compared to doing the whole nose?. ive already had an implant placed and rib cartlidge used for a strut. after all these can a open procedure be done to allow for the nasal struccture to be seen?. is suturing the cartlidges better than removing to refine the ethnic nose or in augmentation rhinoplasty?

Doctor Answers 6

Tip plasty and columella adjustment

Tip plasty can certainly be performed if that is all that is required.  There are very few individuals where the remainder of the nose is in balance with the tip itself being out of balance.  At that point just a tip plasty can be performed and the columella can be brought back and tucked in at the same time by trimming both the membranous and cartilaginous caudal septum.  The tip cartilages can be either sewn together or cartilage can be removed if they are found to be quite wide and flaring at the time of the surgery.  This can be done either through closed or open rhinoplasty techniques depending upon the surgeon’s preference.  

Seattle Facial Plastic Surgeon
4.8 out of 5 stars 143 reviews

Tip plasty and columellar adjustment options

Focusing on just the tip and columella is less work than working on the whole nose, though the fact that your is a revision procedure will make the surgery a bit more complicated. Maintaining as much of the cartilage is generally better than removing it in my opinion.

Thomas A. Lamperti, MD
Seattle Facial Plastic Surgeon
4.9 out of 5 stars 21 reviews

Tip Plasty and Columellar Adjustment

A tip plasty and columellar adjustment, which is significantly less surgery than a full rhinoplasty,  can and should be done at the same time. After 35 years of doing revision rhinoplasties, which comprise 2/3rds of my nasal practice, I feel the open approach would be best, unless an unlikely contraindication is found on physical examination pe-operatively.

Richard W. Fleming, MD
Beverly Hills Facial Plastic Surgeon
4.9 out of 5 stars 38 reviews

Is It Possible to Have a Tip Plasty to Refine the Tip and Adjust the Columella?

Honestly, with the Rhinoplasty history, you gave...nothing at this point would be easy or simple.  Previous tissue dissections, including an Open Rhinoplasty will have left scar tissue making the Tip Plasty more difficult.  The blood supply, to the nasal tip skin would also need to be evaluated.  if the nasal tip skin is cool to the touch, I would not perform an open Tip-plasty as the risk of skin slough increases in that scenario.

Francis R. Palmer, III, MD
Beverly Hills Facial Plastic Surgeon
4.6 out of 5 stars 24 reviews

Tip refinement and columellar adjustment are often done together

The shape and position of the tip is determined by the lower lateral cartilages of the nose and their relationship to the nasal septum (the wall that separates the two nasal passages).  The inner limbs of the lower lateral cartilages come together between the nostrils and serve to provide the form and position of the columella.  So, in essence working on the lower lateral cartilages can affect both the tip and columella.  When a graft has been placed into the area, the original anatomy is altered, but further changes can still be made.  In general, techniques which preserve the structural integrity of the nose are better than destructive procedures (like aggressive removal of cartilage).  Hope this helps.

David W. Kim, MD
Bay Area Facial Plastic Surgeon
4.8 out of 5 stars 37 reviews

Is It Possible to Have a Tip Plasty to Refine the Tip and Adjust the Columella?

It is less work than doing the whole nose but now in your situation doing the procedure requires a revisional surgery.  The structural augmentation already in place would need to be taken into account for the next surgery.  The procedure can be accomplished and your issues addressed but would again need to be done in an open fashion.  To alter the columella height and lengthen the nostrils or project the nose would again require cartilage grafting and rib cartilage or ear cartilage is likely necessary.  Expect also that your defined result would take several more months to heal than your first surgery and the final result would truly take one year.  Hope this helps you with your decision!

Shepherd G. Pryor, MD
Scottsdale Facial Plastic Surgeon
4.6 out of 5 stars 23 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.