Tip refinement - is it possible via closed rhinoplasty?

Question

I am just approaching 12 months post op and love most of my nose however I feel the tip is a little rounded and bulbous. I am due to see my surgeon soon but would like a second opinion to understand if there is a way to fix this without undergoing a full open rhinoplasty like last time.

Randal Haworth, MD, FACS · Answer

Thanks for your question. For refining the tip of the nose, either a closed or open (my preferred method to get maximum control of symmetry) tip rhinoplasty can be performed which refines the bulbous area with minimal scarring.  An open technique allows better visualization and control of the paired cartilages which act in conjunction to define your tip shape and symmetry.  The ability to see both cartilages simultaneously and work on them together allows the surgeon ultimate control over both the shape and symmetry and, of course, beauty of the nose. Make sure you see a board certified plastic surgeon and look very carefully at their before and after photos of other patients. Computer imaging can be a useful tool as well but don't solely rely on that when making your decision.

Russell Kridel, MD · Answer

To
answer your question, yes nasal tip alterations can be performed via a closed
approach. However an open approach provides the surgeon with the ability to
better assess the nasal structures and perform more precise modifications. This
is particularly important in a revision rhinoplasty. The nasal tip is the last
area for swelling to resolve following rhinoplasty surgery. I recommend
consulting with your original surgeon to determine if further refinement is
indicated at this time or if more swelling with come out with time.

Steven Wallach, MD · Answer

I would hold off on doing anything at this point. Your tip may still be swollen. The tip is often the last area for the swelling to subside.

William Portuese, MD · Answer

Yes, a full rhinoplasty, or a tip-rhinoplasty can be performed with a closed approach. Suture techniques, conservative cartilage removal , and cartilage grafting can all be performed either by closed or open approach. Thick skin in the tip of the nose will prevent refinement in that area, so it's important to have realistic expectations. For more information and many before and after examples, please see the link below to our closed rhinoplasty photo gallery

Oleh Slupchynskyj, MD, FACS (retired) · Answer

Either the closed or open approach could be used, however, in a revision case, an open approach is what I would advise as there is direct visualization of the nasal anatomy and any scar tissue that may have resulted from your first rhinoplasty.  The best way to learn about your options would be to consult with your previous surgeon and get a second opinion/evaluation with one or two board certified rhinoplasty specialists - with training and experience specific to the face - and with numerous before/after photos with results you like.  Ask for digital computer imaging during your consultation so you can get a good idea of what your nose will realistically look like after the revision and so that you hopefully will not be having to undergo additional revisions.  
Best,
Dr. S.

David Alessi, MD - Account Suspended · Answer

We do a considerable amount of revisions (over 50% of my rhinoplasties).  Therefore, we have a lot of experience.  Quite often a tip revision does not need an open rhinoplasty.  Of course, pictures first and then an in-office consultation would held to answer your question.  Seek out a board-certified expert in revisions.  Best wishes.

Tip refinement - is it possible via closed rhinoplasty?

Answers (6)

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