What Suggestions Would You Make to Refine the Nose Tip? (photo)

I've been considering rhinoplasty for many years to refine my bulbous tip and asymmetrical nostrils. I hope to start consulting various doctors after the new year, but would like to be as prepared as possible. What are your suggestions in refining the tip, and creating a more narrow (yet natural) appearance? Thank you in advance! I appreciate your advice!

Doctor Answers 12

Suggestions to refine nose tip

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Tip refinement in the bulbous nose is accomplished with suturing techniques in the nasal tip cartilages, which narrows, refines and feminizes the nasal tip.  A small amount of cartilage is sometimes also removed to reduce the bulk of the nasal tip as well.  The width of the nasal bridge can be narrowed through osteotomies.  It is important that the new tip balances well with the remainder of the nose and facial features.  Patients should anticipate mild asymmetries of the nostrils since it is a very difficult problem to correct.

Seattle Facial Plastic Surgeon
4.8 out of 5 stars 158 reviews

Rhinoplasty Techniques Work Fine to Narrow Your Tip

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Hi there in New Jersey;

You appear to be a very good candidate.  It seems that your skin is not overly thick or oily, and the cartilages seem to be quite apparent. Therefore, sculpting the tip cartilages is appropriate.

The entire nose needs to be narrowed. But I feel it would be unwise to only narrow the tip. (I am sure you have been told that in consultations.)

Each surgeon has his or her own technique of refining the tip, but remember it really hinges around:

•    Very careful and symmetrical sculpting of the bulbous cartilage
•    Allowing the tip to overall narrow in the healing process

I would expect you to have an excellent result!

Robert Kotler, MD, FACS
Facial Plastic Surgeon

Robert Kotler, MD
Beverly Hills Facial Plastic Surgeon
4.8 out of 5 stars 90 reviews

Tip rhinoplasty

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Thank you for posting your photos . Very helpful to asses. In my opinion you would benefit from a full rhinoplasty rather than tip rhinoplasty. It appears that you have a sebaceous and mildly thick skin which reduces your chance of getting ideal results.However significant improvement can be achieved by skin preparation ( skin care ), being followed by reduction of your tip cartilages along with their repositioning closing together. The cartilaginous portion of septum need to be freed to come to the midline, to make your nostrils to become more symmetrical. The  tip of your nose need to be slightly rotated upward and you would benefit from lateral osteotomies to narrow down your dorsum. If all is done you will have a more attractive and well balanced pleasing nose. 

Tip rhinoplasty

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Your posted photos show a 90 degree angle between the nose and upper lip, thick nasal skin, a wide bridge, deviation or tilt of the tip and strip of skin between the nostrils toward the left and a parantheses "()" appearance of the dome of the tip.

An infracture of the nasal sidewalls can narrow the bridge. The parentheses appearance can be corrected by trimming the upper edge of the tip cartilages and then suturing them together to rotate them away from the midline. Correction of the tilt will depend on further face to face examination. If the nasal spine is not in the midline it will have to be separated from its base and repositioned. If the bottom of the septum is deviated you will need a septoplasty. If the ligaments between the tip cartilage and septum are disrupted they will need to be reconstructed by sutures between the tip cartilages and the septum. Those sutures and the cartilage trimming can also rotate the tip upward a bit.

It is impossible to tell from the photos but I suspect you may have some valve collapse with inspiration especially on the left.

The most important recommendation I can give you is to see more than one surgeon in consultation and make sure they do a full examination/analysis before making recommendations and proceeding with surgery.

I hope you realize that this format of posting questions and receiving answers lacks the face to face direct communication required for you to make an informed decision regarding your surgery.

My response to your question/post does not represent formal medical advice or constitute a doctor patient relationship. You need to consult with i.e. personally see a board certified plastic surgeon in order to receive a formal evaluation and develop a doctor patient relationship.

Aaron Stone, MD
Los Angeles Plastic Surgeon

Your tip can be narrowed

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A well done rhinoplasty can give you a smaller, narrower tip. See a board certified plastic surgeon, they will tell you what is involved.

William B. Rosenblatt, MD
New York Plastic Surgeon
4.2 out of 5 stars 12 reviews

What would refine my tip?

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You have a nice strong profile and good projection but are wide and boxy at the tip and in the middle and upper nose as well. You need tip reshaping and narrowing of the midlle and upper nose. You don't need large amounts of cartilage removal. If your columella deviation is from your septum then this needs to be fixed. If it is from your tip cartilages then it can be addressed with the tip work.

Michael L. Schwartz, MD
West Palm Beach Facial Plastic Surgeon
4.8 out of 5 stars 12 reviews

Rhinoplasty results are usually very good when you have good tip projection.

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1)   From your pictures, I would say that you are lucky in your anatomy, because it makes for an "easy" operation.  The two key points are the root and the height of the tip.  The root of your nose (between your eyes, called the nasion) looks fine.  And your tip has good projection, so it is simple to refine.

2)    I do the think the nose as a whole needs subtle narrowing.  And you should get a natural result.  That is actually the most important goal.

George J. Beraka, MD (retired)
Manhattan Plastic Surgeon


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Seeing your pictures is helpful but in order to give you the most accurate opinion a complete examination including the airway is necessary. Refining the tip and narrowing the nose can achieve the appearance you are looking for but one needs to be careful not to narrow the airway to much. A cosmetic improvement that leaves you with a functional problem would not make you a happy patient. Good luck

David L. Abramson, MD
New York Plastic Surgeon

What Suggestions Would You Make to Refine the Nose Tip?

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The photos show a boxy nasal tip but also wide mid cartilage and bone secttions of the nose.  The tip can be thinned with eiother a closed or open Rhinoplasty but IMHO, the rest of the nose should be thinned as well to make the nose aesthetically balanced.

Francis R. Palmer, III, MD
Beverly Hills Facial Plastic Surgeon
4.7 out of 5 stars 28 reviews

Refining the TIp

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The bulbous nature of your tip is due to wide and boxy lower lateral cartilages. They cartilages can be easily reshaped to give you a more narrow refined look. I would also narrow your nasal bones as well. Your nostrils could also be narrowed very slightly from a horizontal perspective. Computer imaging would also help you see what your nose would look like after surgery.



Oleh Slupchynskyj, MD, FACS
New York Facial Plastic Surgeon
4.8 out of 5 stars 285 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.