Is It True That the Tip of the Nose Falls if You Remove a Bump on the Bridge?

Question

I had a consult with a doctor who only does rhinoplasties and he informed me that if I wanted my bump removed then he would need to elongate the tip as well. His reasoning was that anytime a bump is removed from the bridge, the tip will also fall. Please let me know if in your experience if this is the case. I would prefer a closed surgery and because of this elongation of the tip, he recommends an open surgery.

Scott Trimas, MD · Answer

Three things can happen after removing a nasal hump. The tip can remain in the same position which is most common if the surgeon does not affect the supporting mechansims of the tip of the nose. Second, the tip can rotate upward if the hump reduction goes all the way down to the tip and includes the cartilage septum at the anterior septal angle. Third, the tip can only fall if the supporting attachments to the septum and the upper lateral cartilages are disrupted allowing the tip to fall. So the bottom line is the tip position is dependent upon what the the surgeon intends to do with your nose not the hump reduction itself.

Thomas A. Lamperti, MD · Answer

In general, taking down a bump on the nasal bridge shouldn't cause the tip to fall. Depending on the surgical approach, though, the tip can become less stable and require extra support to maintain it's current position.

	One thing to consider with removing a bump on the bridge is the matter of preventing pinching of the middle third of the nose as the nose heals. Spreader grafts can be placed in this case to prevent this from occuring.

Ronald Schuster, MD · Answer

Believe it or not your surgeon is correct. The amount of tip support given by the bridge of your nose can vary from patient to patient. Depending upon the strength of the tip cartilages you may or may not need to have soemthing done to the tip of your nose to either hold it in position or even raise it. Your tip appears to be a bit droopy already as it looks to be hanging down just at the end of the bridge of your nose. Even if you didn't ant to change the appearance of the tip itself, i agree that you would need a graft to support the tip, called a columellar strut. If this is all you need it can be done using a closed approach. Perhaps your surgeon has plans to some other things though with the shape of the tip cartilages, in which case an open approach is certainly justified. Good luck.

Amir M. Karam, MD · Answer

Generally, the tip does not need to be elongated following removal of the nasal hump. It does however need to be re-supported in order to prevent it from drooping over the course of healing. Rhinoplasty can weaken the support of the tip so regardless of the maneuvers performed, the support needs to be re-established. This is not the same as making the nose longer. As mentioned earlier, bringing the hump down, the nose will appear longer. This can be modified using other maneuvers to make the nose look balanced.

William Portuese, MD · Answer

That is incorrect. When removing a bump on the bridge, the columella tends to bow downwards and give an illusion of a lengthened nose. After removal of the hump, attention is directed to reduce any columellar show to keep the nose within proportion. Columellar show is a telltale sign of having had a rhinoplasty. Simple hump removal can be done quite easily through a closed rhinoplasty without any elongation of the nasal tip. Open rhinoplasty will extend the healing time with more swelling, bruising, and has other associated complications.

Steven Turkeltaub, MD · Answer

Removal of a bump on the nose does not affect the tip particularly the size that you have. However, in order to obtain an aesthetically pleasing nasal appearance, other changes usually need to be made and this often includes the tip.

	In order to obtain the desired changes in a predictable way, an open approach is the preference of most rhinoplasty surgeons. This also lowers the incidence of requiring a secondary procedure to further improve the outcome.

David A. Bray, Sr., MD · Answer

The nasal tip needs to and should have support of it's own. Removing the hump should have no efffect on the tip. However tip work may be desired as well

Jonathan Berman, MD · Answer

Often if the dorsum is taken down to make the back of the nose straight, the nose appears thin and longer.  Tip work is done to restore balance to the nose.  The delicate balance of this tip rotation and decreased tip projection and nasal bump take down is what rhinoplasty is all about.

	This delicate "balancing act" is why the surgery is not a operation of just taking down the bump.  There is artistry to the surgery----balancing the appropriate bump take down with appropriately trimming the tip cartilage.

Richard W. Fleming, MD (retired) · Answer

The tip will not fall if only a hump is removed during a rhinoplasty. However, tip position may have to be altered to maintain good nasal proportion. Your tip does appear to be wide and poorly defined; changing contour and position may be beneficial. I recommend you have an open approach if that is what your surgeon recommends - I have used the open technique in some noses for over 30 years with very satisfying results.

Donald Nunn, MD (retired) · Answer

In general removal of the dorsal hump should have minimal effect on the nasal tip. Sometimes the tip may need support from cartilage grafts with an open rhinoplasty technique. Donald R. Nunn MD Atlanta Plastic Surgeon.

Is It True That the Tip of the Nose Falls if You Remove a Bump on the Bridge?

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