Tip only rhinoplasty, local anesthesia? (photo)

Question

I am a 33yr old woman, and I've been wanting to change my nose for years. I am ok with the little bump in my nose but what I really want to change is the tip. Is there any way to lift the tip slightly and make it narrower (so it doesn't look bulbous) using only local anesthesia? I'm realistic &don't expect a perfect nose; I just want it to look better. I am not nervous, anxious or squeamish about the procedure. I just don't like the idea of IV sedation and won't do general anesthesia.

John Bitner, MD · Answer

I disagree with the other responses.  While some minor modifications of the tip can be done with local anesthesia only, I don't believe that is the case with you.  In order to rotate your tip and decrease the bulbousness, you will need a cephalic trim of the lower lateral cartilages (either open or closed with dome delivery) and a columellar strut graft.  You will also need to lower the septum in the supratip and probably caudally.  Finally, while I agree that your tip is the most important part of your rhinoplasty, you need your dorsum lowered (including the radix).  While not everyone needs a full rhinoplasty, some need only a tip or only the dorsum, that is not the case with you.  Through sad experience I can recommend that you do it right the first time.  Do a full rhinoplasty and save yourself repeat trips to the OR.

Toby Mayer, MD · Answer

Your tip can be done with a tuboplasty under local anesthesia without any problem. Based on the information you discussed you shouldn't have no problem with doing it this way.

Frank Agullo, MD · Answer

Some rhinoplasties can be done with local anesthesia with mild oral sedation. You are an ideal candidate. The tip can be refined and even the hump removed without general anesthesia. I like to use the Vectra 3D system so you can visualize the results prior to surgery in three dimensions.

Kenneth Hughes, MD · Answer

I think that your goals are achievable with regard to tip refinement.  I  would not perform this under local, as you will be fighting your own secretions and bleeding.Find a plastic surgeon with ELITE credentials who performs hundreds  
of rhinoplasties and rhinoplasty revisions each year.  Then look at the 
 plastic surgeon's website before and after photo galleries to get a   
sense of who can deliver the results. 	Kenneth Hughes, MD Los Angeles, CA

William Portuese, MD · Answer

There are only a few people were able to undergo a tip-plasty alone. Most patients need to undergo a full rhinoplasty to make sure the nose appropriately shaped and balanced with its own features, and/or your facial features. Performing only a tip-plasty in this particular case will be a mistake because the tip will not balance with the remainder of the nose. There are far too many nerve endings in the nasal tip to successfully perform this surgery comfortably, so we recommend general anesthesia for all tip plasty surgeries and all rhinoplasty surgery. We do this is for patient safety and comfort.

Tip only rhinoplasty, local anesthesia? (photo)

Answers (5)