Why is There a Limit to How Much the Nasal Tip Can Be Reduced?

Question

Im very curious for your professional opinion as to why there is a limit to how much the nasal tip can be reduced/less projected when it is cartilage? Thank you

Howard Webster, MBBS (Hons), FRACS · Answer

This a great question.

	The key to understanding the concept of shape change in the nose is to appreciate that the tip is not just a lump of cartilage which can be carved into a different shape.

	The nasal cartilages - and the nasal bones - are a thin shell, with complex and variable shapes.  They connect with each other and the shape of each affects that of the others. There are muscles attached to each, which open and close the nose up when you breathe.  The "design"of the nose is not about shape - it's evolved to produce adequate amounts of cleaned and humidified air to your lungs at all levels of activity and in all climates.

	On top of the cartilage is skin of variable thickness. On the inside of the cartilage is the skin lining the nose, called the mucosa.  This is reactive to allergens and temperature and humidity.

	When undertaking a rhinoplasty, planning involves shape changes which are possible, which are what the patient wants, and which don't reduce the airway functions of the nose - or indeed they might improve it.

	The overlying skin has to conform to the new shape also.

	So it's tricky and requires a great deal of experience to achieve consistent surgical outcomes in rhinoplasty. And there are limits to what can be done.

	I hope this is what you were looking to understand.

	All the best.

John M. Hilinski, MD · Answer

Part of the answer has to do with the overlying skin. In patients with thicker than average skin, you can reduce the cartilage down in size but the skin will not shrink wrap as much. Therefore, you will lose some shape and definition in this process. In other cases, the cartilage framework of the nose is too delicate to reduce its size any significant amount. To a certain degree, you have to maintain sufficient structural support for function of the nose.

Kenneth Hughes, MD · Answer

The lower lateral cartilages are composed of different segments, but they need to be continuity and have enough strength to keep the external nasal valves open. Also, many people do not like a pinched look, which can happen as well. Kenneth Hughes, MD Los Angeles, CA

William Portuese, MD · Answer

The lower lateral cartilages of the tip are paired, 3 dimensional structures , shaped like 2 horseshoes. They are integral to the entire tip. De-projection of the tip can be accomplished thru a variety of techniques, including tip surgery, shaving down the dorsal septum, removing the nasal spine etc. It is very important to keep the nose in balance and breathing properly. Examples can be seen on our rhinoplasty photo gallery/overly projecting noses

Steven Wallach, MD · Answer

You are limited somewhat by yoru anatomy in terms of a nasal reduction. The goal is to preserve function, not destroy the architecture.

Michael L. Schwartz, MD · Answer

Rhinoplasty alters the underlying bone and cartilage structure of the nose. the skin must then shrink to conform to this new structure to see the result. In patients with very thick skin it may be unable to do this no matter how much you reduce or shape the cartilage. In fact patients with thick skin often need to have cartilage added to create a strong shape that will show through the thick skin.

	In very thin skin the opposite can occur where it shrinks so much that the cartilage becomes distorted, angular and pointy.

Ashok Govila, FRCS, MCh, MS - Account Suspended · Answer

Thanks for the question. I don’t personally think there is a limit to reduce the tip projection. Tip projection can be reduced to whatever is desired by the patent on photo animation, with total preservation of function of nasal valve. Tip projection correction involves reducing the size of the lower alar cartilages and there are many more structures like the caudal end of the septum that can be reduced to reduce the tip projection more without out taking off too much of LLC.I am not if this makes things clear for you but I am sure most PS will understand what I am talking. Wish you all the best

Why is There a Limit to How Much the Nasal Tip Can Be Reduced?

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