Tip only rhinoplasty possible for me? (Photo)

Question

Is a tip rhinoplasty w/ minor shaving and straightening possible using local anesthesia and oral sedation? I’ve had an Otoplasty under local only and did well, and I really want to do my rhino this way, but finding a Dr to do this has been difficult. Can any improvements be made to my tip with this approach? Even if it is minor? Thank you

Kim Patrick Murray, MD · Answer

Thank you for sharing your concerns and photos. Based on what you’ve described and what is visible, this is not simply a matter of a minor tip procedure.
The nasal tip appears heavy, with large lower lateral (alar) cartilages and insufficient structural support. In this situation, a limited tip plasty alone would be unlikely to provide a stable or natural long-term result. In fact, inadequate support in a heavy tip can increase the risk of distortion over time and raise the likelihood of revision surgery.
A formal rhinoplasty allows the tip to be properly supported, reshaped, and balanced with the rest of the nose and face. Most of the precision work in rhinoplasty is focused on the tip, and when performed correctly, a full rhinoplasty does not look “overdone.” Rather, it allows for a more natural, durable, and predictable result.
Patients are often understandably concerned that a rhinoplasty sounds more extensive than a tip procedure, but in cases like yours, a well-planned rhinoplasty is actually the more conservative and reliable approach. It allows for better structural control, improved long-term stability, and a lower risk of needing future revision.
When done properly, this approach can create a strong, masculine, and natural-appearing nose that remains stable over time.

Justin L. Bellamy, MD · Answer

Hello, while it appears most of your concerns are related to the tip, it is important to remember that typically specialized rhinoplasty surgeons prefer to take a comprehensive approach to the nose to ensure that your final result is adequately balanced, as changing one feature of the nose can often alter the appearance of another.
That said, you have a boxy tip with redundant cartilage that will require significant cartilage reduction and stabilization. To do this in a predictable and long-lasting fashion will require a septal-extension cartilage graft to stabilize your tip cartilages. This cartilage is typically taken from your own septum, which is most safely harvested under anesthesia to prevent bleeding into your airway. It is possible to purchase off-the-shelf rib cartilage to use instead of your own septal cartilage, which might allow an ambitious surgeon to perform this procedure entirely under local. But as you can see, there are several benefits to doing this procedure under anesthesia with very little downside, which is why you may find surgeon reluctant to do it under local anesthesia. You would likely be compromising quality.

Muhammed Fatih Evcimik, MD · Answer

Hi TaylorI just don't recommend tipplasty. I do not recommend it under local anesthesia. If it is to happen, it should all be together because a disproportionate image will emerge. The top side is different, the bottom side is different. It would be better if the bullous type appearance is essentially corrected under general anesthesia, without touching the upper part too much. If you have a photo from the side, if you share it, at least the projection will be evaluated.

Ruslan Zhuravsky, DO · Answer

Hi, great question. Yes, it is possible. I do full rhinoplasties, and even difficult revisions under local anesthesia. Oral medications are given for pain and relaxation. However, I do not like IV sedation as this slightly deeper form can inhibit certain reflexes and increase risk for aspiration. Our patients love the "awake rhinoplasty" approach as it by passes anesthesia and it's associated issues. The surgery and results themselves are identical, so the results are not compromised in any way at all. Hope that helps! Good luck.

Man Koon Suh, MD · Answer

Your nasal tip exhibits a bulbous appearance with a bifid tip shape, along with noticeable tip asymmetry and a slight retracted alar rim. It's essential to possess the expertise needed to prevent exacerbation of the retracted alar rim while correcting the bulbous tip through lower lateral cartilage realignment. When dealing with the lower lateral cartilage, achieving the desired results is challenging through simple shaving alone. Both trimming and realignment are typically required, and depending on the specific circumstances, cartilage grafting may also be necessary. Local anesthesia can be administered if preferred.

Steven M. Denenberg, MD · Answer

You have two very strong and asymmetric tip cartilages, like the woman whose before and after I posted with this answer. You can see and feel the little dent between those cartilages. And the bridge looks wide as well, and also asymmetrically wide. Minor shaving would make no changes to your nose -- in face, you should run from any surgeon who suggests it! However, with IV sedation, you don't need general anesthesia and a breathing tube, so maybe that would be a compromise for you.

How *much* to narrow the tip, or adjust the bridge, or make other changes? We figure that out with morphs, well before surgery. I'd love for you to see some excellent professionally-designed morphs of what could possibly be done with your nose. Morphs could also help you identify better just what's bothering you, and help you set a goal for the rhinoplasty that's accurate for your tastes. Profile and three-quarter views would be particularly important in morphing your nose. (Side note: in my opinion, morphs should really be done by the surgeon, or he should direct an assistant as she makes the morphs. Morphs should be made with a constant eye to what actually *can* be done in surgery, for that particular nose, and the surgeon has that information and judgment best.)

Finally, remember that rhinoplasty is an exquisitely difficult operation to get right, and you should only have surgery if you are able to make yourself very confident in your surgeon's skills. The changes that your nose needs require advanced techniques, and skill that most plastic surgeons don't possess with expertise. For most noses, it's much better to not have surgery than to have inexpertly-performed surgery. Read my essay on how to stay out of trouble while selecting a rhinoplasty surgeon. And it also discusses how to take photos that are best for online evaluations.

Selcuk Inanli, MD · Answer

Hello! Thank you for your question.From the photos you provide us I understand that you have a very thick skin, your nose look like crooked to the left side and nostrils are too small. For this reasons I recommend you an open rhinoplasty. Because with the tip plasty your nose would not be change too much. And the things that bother you cannot be solved with this operation. Best Regards!

Eric M. Joseph, MD · Answer

Based on your photos, you appear to have thin nasal skin with a wide irregular and asymmetrical nasal tip appearance. This could be due to a deviated nasal septum internally since your nose has a bit of a reverse C shape. In that regard, I do not believe that Tip plasty alone would be completely helpful for you. The reason we offer nearly exclusively use general anesthetic during rhinoplasty procedures is to protect somebody's Airway from aspirating blood during the procedure. I hope this is helpful! Sincerely, Dr Joseph

Lucian Ion, FRCS · Answer

Thank you for your question and sharing your photograph.

Rhinoplasty under sedation is a possibility but with some limitations compared to general anaesthesia.

In general, changing the contours of the nasal tip does require additional support. This support is typically obtained from the nasal septal cartilage which is more uncomfortable under sedation but it is possible technically. The alternative can be to use costal cartilage from a donor for support to the nasal tip.

To a great extent, the feasibility depends on the degree of change in the characteristics of the change that you wish to achieve. Because the nasal bridge is also slightly wide at the keystone area, a narrower appearance of the tip may introduce an balance if the bridge is not adjusted similarly.

A final point would be to say that if you are struggling to find a surgeon that does rhinoplasty under local anaesthesia and intravenous sedation it may be because it is perceived as a significant limiting factor. Facelift surgery and neck lift surgery are done frequently under sedation suggesting that it is not resistance from the surgeons using this type of anaesthesia but rather how appropriate it is, in order to deliver the results the patients expect.

Thomas Spalla, MD · Answer

Rhinoplasty surgery can be a bit more complicated and involved than a lot of non-rhinoplasty surgeons realize. Your surgery may require septoplasty as well to ensure a straight and stable platform for your nasal tip.

Given the potential for bleeding into your airway, many/most rhinoplasty surgeons prefer to perform such surgery under general anesthesia to ensure a safe airway.

While local with sedation may be possible, it will likely be challenging to find a surgeon willing to do this - for your safety and comfort as well as theirs.

Tip only rhinoplasty possible for me? (Photo)

Answers (15)

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