Is there any other less invasive procedure that could benefit the removal of the droop permanently? (Photos)

Question

Hello, I have met with a great plastic surgeon who has advised on a full Rhino septoplasty however, I don't want such an invasive procedure. I dislike my droopy tip, especially when i smile. Is there any other less invasive procedure that could benefit the removal of the droop permanently? I find i have a lot of excess cartilage in the tip and i feel removal of the cartilage and rotation of the tip can improve my side profile.

Eric M. Joseph, MD · Answer

Based on your photos, you have an overprojected nasal profile appearance with a dorsal hump and a pointy droopy tip. If you are looking to achieve a less distracting and more feminine nasal profile appearance, I am unaware of any non-surgical techniques that would address your concerns. Thank you for your question and I hope this is helpful. Sincerely, Dr Joseph

Jonathan Kulbersh, MD · Answer

Thank you for your question and photos. Since you’re only interested in changing the appearance of your nasal tip, you may be a candidate for tip rhinoplasty. This procedure doesn’t require that the nose bone be broken or reshaped and instead focuses on redefining the tip and narrowing the nostrils. 
Even with a focus solely on the nasal tip, rhinoplasty is still considered one of the most complex of all plastic surgery procedures, requiring experience, skill, and even artistry to achieve an optimal outcome. I recommend scheduling an in-person consultation with an experienced, board-certified facial plastic surgeon, with expertise in rhinoplasty techniques. They will be able to discuss your concerns with you and help you decide on the best approach.

Selcuk Inanli, MD · Answer

Hello! Thank you for your question.From the photos you provided your nose is droopy and you have a very visible hump. I highly recommend you a rhinoplasty surgery to get rid of the droopy tip. This is the only permanent solution. I can understand that you may be a little afraid of getting a full surgery under general anesthesia but I can assure you that most of the post-op patients say that after the surgery they don't have too much pain. More than pain you may expect some discomfort especially when you have the cast, but after the cast removal you will feel way better. Best regards!

Mehmet Durmusoglu, MD · Answer

First of all, thanks for your question. In more than 95% of patients, applying all steps of rhinoplasty is necessary. For the remaining 5%, tipplasty (correction of only the tip of the nose) or alarplasty (correction of the nostrils) or to reduce the projection only may be sufficient. I think making this decision will be appropriate after a thorough evaluation. Yes, some patients find a complete nose job worrisome. With new techniques (such as ultrasonic rhinoplasty), good results can be obtained at the end of a very comfortable process. I wish you a beautiful and a healthy day!

Lucian Ion, FRCS · Answer

Thank you for your question and sharing your photographs.

I suggest that you try using a computer simulation with only adjustments to the nasal tip. It may generate a contour that you would still find objectionable, but if you find that this is the right type of change for you, it would be possible to discuss with your surgeon regarding a tip plasty as opposed to a full rhinoplasty.

Reduction and reshaping of the cartilage involves surgery. The nonsurgical alternative is to use injectable filler or threads but these techniques are not permanent.

Steven M. Denenberg, MD · Answer

I agree that rotation of the tip can improve your side profile. It's not *removal* of the tip cartilages that does that, but rather *repositioning* of the cartilages. And accomplishing that is *most* of a rhinoplasty! I say that, because the work on the tip is the most complicated part of the procedure. What that means is, yes, you would require a rhinoplasty to make the change, but if you're "in" for rotating the tip, that's most of the deal.
How *much* to elevate the tip, or make other changes? We figure that out with morphs, well before surgery. I'd love for you to see some excellent professionally-designed morphs of what could possibly be done with your nose. Morphs could also help you identify better just what's bothering you, and help you set a goal for the rhinoplasty that's accurate for your tastes. Profile and three-quarter views would be particularly important in morphing your nose. (Side note: in my opinion, morphs should really be done by the surgeon, or he should direct an assistant as she makes the morphs. Morphs should be made with a constant eye to what actually *can* be done in surgery, for that particular nose, and the surgeon has that information and judgment best.)
Finally, remember that rhinoplasty is an exquisitely difficult operation to get right, and you should only have surgery if you are able to make yourself very confident in your surgeon's skills. The changes that your nose needs -- particularly the amount of tip rotation you're looking at -- require advanced techniques, and skill that most plastic surgeons don't possess with expertise. For most noses, it's much better to not have surgery than to have inexpertly-performed surgery. Read my essay on how to stay out of trouble while selecting a rhinoplasty surgeon. And it also discusses how to take photos that are best for online evaluations.

Thomas Spalla, MD · Answer

Given the nasolabial angle is less than 90, elevating your tip is indicated to improve this. Since you desire permanent improvement, I agree with your surgeon that a rhinoplasty is in order. As we age, the tip becomes more ptotic, so this will worsen with time.
If you are adamantly opposed to surgery, Botox to the depressor muscle can alleviate some of the downward pull - especially with smiling. Sectioning this muscle is also possible. Additionally, grafting to the nasal base along the nasal spine can help to push the tip upwards but wouldn't affect nearly as much change as is possible with a rhinoplasty.

Robert Ciardullo, MD · Answer

Can the nasal tip be elevated without a full rhinoplasty? while elevation of the nasal tip would be the primary objective in your case, I don’t think it would look as nice as possible if you don’t also reduce the dorsal hump. If you are looking for the least invasive procedure perhaps you should consider closed rhinoplasty.

William Portuese, MD · Answer

A less invasive closed rhinoplasty approach can accomplish shaving down the hump, and refinement of your nasal tip cartilages and lifting the tip of your nose statically. Releasing the depressor septi ligament will prevent the tip of the nose from drooping dynamically. Choose your rhinoplasty specialist wisely, since this procedure is the hardest operation to perform correctly in the entire field of cosmetic surgery.

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