Would tip plasty be sufficient to narrow my bulbous nose and balance my features? (Photo)

  A rhinoplasty to refine the tip and improve the bridge would probably be better to keep the nose in balance.Kenneth Hughes, MDLos Angeles, CA

Improving  and refining a
bulbous tip are frequent requests of patients wanting nasal refinement.
It is possible to improve the cosmetic appearance of the tip alone without
altering the rest of the nose in some patients. Whether the optimal option in
your particular situation would be a tip rhinoplasty alone or a full
rhinoplasty would best be determined at a consultation. Either procedure can be
performed with a closed or open approach. The goal should be a balanced natural appearing nose.

Following the advice from a surgeon on this or
any other website who proposes to tell you exactly what to do based on limited
2 dimensional photos without examining you, physically feeling the tissue,
assessing your desired outcome, taking a full medical history, and discussing
the pros and cons of the operative procedure would not be in your best
interest. I would suggest you find a plastic surgeon with extensive nasal
surgery experience who is certified by the American Board of Plastic Surgery
and ideally a member of the American Society for Aesthetic Plastic Surgery
(ASAPS))
or the Canadian Society for Aesthetic Plastic Surgery (CSAPS)  that you trust and are comfortable
with. You should discuss your concerns with that surgeon in person.

Robert Singer, MD FACS

La Jolla,California

I think a balanced rhinoplasty including probably taking down the dorsal hump would be an appropriate thing to do if you are interested in a rhinoplasty.

 When a large dorsal hump is present, a full rhinoplasty is required, not a tip plasty, otherwise the nose will be significantly out of balance. The bulbous tip is addressed with suture techniques applied to the lower lateral cartilages of the tip to narrow it. The dorsal hump  must be shaved down to match the new tip, and osteotomies of the nasal bones are required to narrow the bridge line. For many examples  and more information, please see the video and the link below 

Your photos block out key components in evaluating the nose. The nasofrontal lateral view is blocked. If this is lower you possibly would need something done here to "balance" your nose (cartilage graft). Your dorsum may be a bit high as well. As far as your tip it is slightly bulbous. Since I cannot see the inner aspect of your eyes it is hard to determine if the base of your nose is too wide (that is best way to determine this). It also appears you would need a small tip rotation from what I see on your lateral view. I would recommend yo see a surgeon who has a good history and experience doing rhinoplasties. If they have imaging that can be helpful for you to see what the possile outcomes could be.

Dear
sunnygirl7,

Thank
you very much for your clinical post and photographs. Although difficult to tell from the angles
provided, it does appear that you have a wide bridge of the nose as well as a
bulbous tip. The length of the nose and
the influence of smiling on your nostrils cannot be fully assessed. In my over 20 years of experience of
performing cosmetic rhinoplasty, it has been experience that just simple
reduction tip plasty will result in imbalancing of the other bony soft tissue
features of the nose. When narrowing the
tip, a wide bridge will often look wider and can be quite aesthetically
displeasing.

The
simplest way to fully evaluate a potential rhinoplasty with a patient to decide
whether tip plasty or full rhinoplasty with work on the nasal vault and bony
pyramid is to do computer imaging. I
have been performing computer imaging for 20 years and the ability to
understand and interpret patients’ aesthetic desires and show them the
nasal-facial balance and proportion from different manoeuvres is extremely
helpful. Use of computer imaging can
show patients just what a tip plasty would do to the aesthetic appearance of
the face and nasal-facial balance, as well as an isolated bony bridge reduction. Through this type of computer imaging,
patients get a better understanding of what type of aesthetic consequences can
be achieved with different rhinoplasty manoeuvres.

I
was fortunate to train in both plastic surgery and ear/nose/throat-head/neck
oncology surgery and facial trauma. The
ability to perform accurate computer imaging and show patients very closely
what the results of their rhinoplasty surgery should be helps patients decide
which kind of aesthetic nasal alteration best achieves the nasal-facial balance
and proportion beauty that they are seeking.

For
more information, please review the link below.

I
hope this information has been of some assistance and best of luck. At this point in time, seeking the
consultation of two or three very experienced rhinoplasty surgeons would be
very helpful and give you a sense of which rhinoplasty surgeon you feel most
comfortable with.

Sincerely,

R.
Stephen Mulholland, M.D.

Certified
Plastic Surgeon

Yorkville,
Toronto

In my opinion, a full rhinoplasty would narrow the nose and the tipplasty can reduce and refine the tip.  Sometimes, patients can have just a tipplasty, but other times, a full rhinoplasty is necessary to balance the nose.  The goal is for a very natural appearing nose.

As my colleagues have stated, a tip plasty will provide refinement of your nose. Many times, after examining the nose properly and chatting with the patient, we do recommend going ahead with a reduction rhinoplasty and altering the other components of the nose in order to achieve a better balance. This, of course, will be based on the individual wishes and outcome desires of each patient.