Could a Tip-plasty Help? (photo)

My columella slants to the right and this pushes up my right nostril (and cartilage?) quite a bit. My nose is obviously very asymmetrical, bulbous and I also have crease, which I can't stand. Could a tip-plasty help fix this? I'm not looking for perfection, but there's obviously lots of room for improvement here. I generally like the shape and size of my nose, I just wish it were more even and didn't have a crease. Could this potentially be done closed and with a local and IV sedation?

Doctor Answers 8

Twisted and Bulbous Nasal Tip/Whats the best way to treat?

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Have reviewed your photos: first the cause of the twisted tip and the crease that you see.

  1. The partition that separates the nostrils is deviated at the end and the most common cause is an injury. Becuase it is warped to one side it changes the position of the tip and the secondarily the demensions of the nostril.
  2. The crease that you see is actually natural.. it is the depression between the small cartilage portion of your tip that give it its larger bulbous shape.

The Recommended Treatment for a twisted and bulbous tip is:

  • A straightening of the twisted partition (distal septoplasty)
  • A sculpting and rearrangement of the tip cartilages to reduce and reshape the tip and to hide the crease that you don't care for.(Tip Rhinoplasty)

Corrective Procedure: operative time 1 1/2hr; anesthesia local I.V. sedation; outpatient;pain level 2-5; dressing removed in 6 days; socially presentable 1 week.


Eau Claire Plastic Surgeon
4.7 out of 5 stars 22 reviews


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A tip plasty can certainly be performed under closed rhinoplasty techniques.  However, it is best to perform the tip plasty under a general anesthesia.  The tip of the nose is difficult to get completely numb and does require multiple injections which are not tolerated well under IV sedation.  Any bleeding flowing down the back of the nose can also cause an airway issue, so it is always best to have nose surgery performed under general anesthesia with a protective airway for patient safety and comfort.  The columella can be straightened, the bulbousness can be reduced, asymmetries addressed, and the crease between the 2 cartilages can be addressed as well with either suturing techniques or a small cartilage graft.

William Portuese, MD
Seattle Facial Plastic Surgeon
4.8 out of 5 stars 158 reviews

Could a Tip-plasty Help?

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 I have performed Rhinoplasty for 25 years and IMHO a Tip Plasty would aesthetically improve the nasal tip.  There are numerous things that could be done aesthetically to the tip including closing the cleft.  Rhinoplasty is best performed under general anesthesia with a secured airway.  The nose is very vascular and can bleed during the Rhinoplasty.  With a local or IV sedation no tube is placed through the vocal cords.  This tube support breathing as well as stops blood from entering the lungs and causing a pneumonia.  You may find some Rhinoplasty Surgeons who offer this approach but I would decline as it's just not as safe for you IMO.

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

Nasal Tip-plasty

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A tip-plasty will improve your asymmetrical, bulbous, wide tip. An experienced surgeon will  improve your tip and make it proportional to the rest of your nose.  

Richard W. Fleming, MD
Beverly Hills Facial Plastic Surgeon
4.9 out of 5 stars 43 reviews

Nasal Tip Modification

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Dear Maya,

Based on your photos (although not very clear), the slight overprojection of the nasal tip and its crease as well as the asymmetrical nostrils could be fixed with an alarplasty and a tip modification; rebuilding the cartilage in your nasal tip will allow the surgeon to fix the noticeable tip crease.

Please remember that commendable results require an exceptionally skilled surgeon to perform the surgery and settling for anything less than that increases the chances of corrective surgeries dramatically.

I hope this helps.

Thank you for your inquiry.
The best of luck to you.

Dr. Sajjadian

Ali Sajjadian, MD, FACS
Orange County Plastic Surgeon
5.0 out of 5 stars 205 reviews

Tip plasty for the bulbous tip.

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Yes a tip plasty would improve things as long as it goes with the rest of your nose. Select an experienced rhinoplasty surgeon for the best result and one who does noses that u like since that is what you will be getting!

Toby Mayer, MD
Beverly Hills Facial Plastic Surgeon
4.8 out of 5 stars 38 reviews

Tip plasty only?

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Yes. I believe all your concerns could be addressed with a closed tip platy under local IV sedation. You need to see a rhinoplasty surgeon who is comfortable with this technique.

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

Is tip plasty the right choice?

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Good photos. Your septum might be a bit deviated which is tilting the tip to the right. So that might need to be fixed as well. The crease is the small space between the tip cartilages. This would get fixed with tip plasty. Go see a rhinoplasty surgeon for a thorough consultation.

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.