Why do plastic surgeons raise the nasal tip of every single rhinoplasty patient?

Question

I had a tip rhinoplasty for a bulbous tip done years ago and I've always been dissatisfied by how the surgeon raised the tip of my nose--leading to too much nostril show. I've been searching for a surgeon to correct this, but the more I look at surgeons' before and afters---it seems like EVERY surgeon raises every patient's nasal tip---whether it looks appropriate for a patient's features or not. A lot of patients look worse afterwards (creating a "miss piggy" look). Why on earth is this?

Kenneth Hughes, MD · Answer

The goal of rhinoplasty should be to create natural results.  I would have to say that this is something that may be more common for a certain surgeon or surgeons.Kenneth Hughes, MDLos Angeles, CA

Toby Mayer, MD · Answer

Bulbous tip raised up too much. Not all surgeons do this. See a revision rhinoplasty surgeon. Your tip can be lengthened to restore your nose.

Richard Dale Reynolds, MD · Answer

Some tips have to be lowered, some have to be raised and many need to be neither raised or lowered. It depends on the patient and their anatomy. Each case is unique and should be treated as such. The tip should only be raised if it is too low to begin with.

Sam P. Most, MD · Answer

I would respectfully disagree with your assessment.  Perhaps in your case this has occurred, but in general, a good surgeon would evaluate the nose and with you (the patient) decide on what the best tip position would be.  When looking at before and after images, keep in mind that a droopy tip (ptotic tip) is a common complaint in rhinoplasty surgeons' offices, so many of the patients who come in actually do benefit from some tip rotation (upwards), but this is always done on a case-by-case bases.Hope this helps.Best,Dr. Most

Stephen Weber MD, FACS · Answer

I don't think that this is the case. It is true that many rhinoplasty patients do want an increase in rotation or upturn of their nasal tip. However, the result should be customized to the patient's desires, their facial features and height. If you're having trouble finding a surgeon to de-rotate your nose, keep looking for someone with before and after photos that represent results that you find natural and pleasing and not overly rotated. I hope this information is helpful for you.Stephen Weber MD, FACSDenver Facial Plastic Surgeon

Kimberly Lee, MD · Answer

Not every surgeon raises the nasal tip during rhinoplasty surgery.  Everyone's nose is different, and each patient has different needs and desired results.  This is why the consultation and preoperative planning process is critical before any surgery.  Please consult with a board certified specialist who can assist you with achieving the results you seek.  3-dimensional computer imaging can also help you visualize what you may look like afterwards and serve as an important communication tool with your surgeon.

Stephan Finical, MD · Answer

Tip rotation can be controlled during a rhinoplasty. Removal of part of the cartilage that gave you a large tip volume allowed the tip to rotate up. There are techniques that can be used to control tip rotation. This is particularly important in males. Not all tips have to move up.

J. Andrew Bartlett, MD, FRCS · Answer

Certain tip narrowing techniques to narrow the tip on the frontal view may lead to some upward rotation of the tip, depending on your  anatomy and the degree of tip narrowing desired.  This  can be prevented in many cases with partial resection of the medial crurae of the tip cartilages. Excess columellar show can be manged with a composite cartilage graft of skin and cartilage from the ear  during the initial procedure . This could also be considered now.  There may also be other methods to rectify this issue but it is difficult to comment further without pictures.  Hope these points are helpful.

Frederic H. Corbin, MD (license restricted) · Answer

Thank you for your question and clearly most surgeons try to customize the result of nasal surgery to the patient's desires.  That said an elevated and rotated tip can be brought back down as desired.  I use digital imaging prior to surgery to allow patient's to see how their nose might look following surgery and to get their exact input as to how they would like it to look.  That way going into surgery the patient is fully informed as to what can be done and I know exactly how they want their nose to look.Dr. Corbin

Richard W. Fleming, MD (retired) · Answer

Every plastic surgeon does not raise the tip of every rhinoplasty patient. The problem of an over-rotated tip or short nose is not rare and this can be corrected depedning on a patient's needs. You should consult with a surgeon who provides natural results that you like.

Why do plastic surgeons raise the nasal tip of every single rhinoplasty patient?

Answers (11)

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