Deprojecting nose tip with open or closed rhinoplasty? (Photo)

may suffice in your case; you are a routine case in rhinoplasties; you need dorsal shaving, slight tip work and tip shortening.

Closed rhinoplasty techniques can accomplish the goals of de-projection of the tip, shaving down the dorsal hump, and adjusting the tip accordingly. Usually, 3-4 mm of de-projection is accomplished. For many examples of nose is similar to your own, please see the link and video below to our closed rhinoplasty photo gallery

Dear waitingmywholelife,

Thank you for submitting your clinical photos and clinical
question. Rhinoplasty, whether closed or
open, resulting in an enhanced nasal-facial balance and proportion can be
performed well, both through a closed and open approach. I have been performing rhinoplasties for 20
years, having trained in both plastic surgery and ear/nose/throat, head/neck
oncology. Rhinoplasty is an important
part of my practice. In general, over
the years, I have found that the open approach, although having slightly more
swelling of the tip during the early recovery period, provides a much more
predictable, long-term, stable result than closed rhinoplasty. The open approach will allow stabilization of
the deprojected nose with visualization of well-placed graphs and sutures and a
very accurate balancing of the nasal bridge to the new height and tip
projection as well as shortening of the overgrowth of your internal septum.

Closed techniques, such as the delivery or
intracartilaginous, particularly is a delivery technique is performed, will
lead to a significant amount of edema and all one really saves is a very small
transcolumellar incision. In my 20 years
of performing external rhinoplasty, the revision rate for the transcolumellar
incision is under half a percent, but
accurate anatomical reductions through the open technique in a well-trained
surgeon’s hands should have a revision rate of under 2%.

There are many fine rhinoplasty surgeons who can perform open
and closed rhinoplasty. At this point in
time, rather than focusing on the approach, seek consultation with plastic
surgeons and facial plastic surgeons with significant expertise in rhinoplasty,
whether open or closed. For the past 15
years, I have found that performing computer imaging during the consultation
with the patient and showing the range of improvements that I think they’re
trying to achieve and that can be realistically and predictably delivered helps
patients in deciding how much of a reduction rhinoplasty should be performed.

This “try before you buy” approach will go a long way to
reassuring you the type of reduction that will best balance your nasal-facial
aesthetics.

For more information, please review the link below.

I hope this information has been of some assistance and best
of luck.

Yours sincerely, R. Stephen Mulholland, M.D.

Certified Plastic Surgeon

Yorkville, Toronto

While your tip is over-projected, it is not as bad as you describe because a lot of the excess projection is secondary to the position of your septum, something we call a "tension" nose. While I'm a fan of open surgery , being one of the first surgeons in the United States to use this technique, I don't feel this will be necessary in your case.

Hello,A reduction rhinoplasty will address your concerns quite nicely. This can be done equally well via an open or a closed approach. This will depend on your surgeon's preference and expertise. The amount of deprojection and shortening has to be tailored to your face and your needs, it difficult to give you a precise measurement based on a couple of photos. I hope this helps.