Can a nose tip revision be done without breaking the bone? (photos)

Question

I am trying to find out more information on rhinoplasty work exclusively for the tip of my nose. I have no issue with the rest of my nose but have long disliked my bulbous tip. I would like to see it raised (but no ski slope) and smaller with better definition in the nasal area and smaller nostrils. The photo below I manipulated with an app of what end result I am looking for. Is it feasible to do that and not break the bone? What is the down time for tip surgery? Approximate price range?

Steven M. Denenberg, MD · Answer

Often, work on the tip turns out to be *most* of the rhinoplasty anyway. Click on the "Web reference" link, just below my response, or go here:
FacialSurgery.com/RealSelf/RealSelf_lydiaabrams.html
I made a computer morph of your nose, and an animation of the morph, to show the changes that are possible for your nose in truly expert hands.I elevated the tip, and brought it back a little closer to your face. The particular photo you posted didn't show the bulbousness very well.I also lowered the bridge a touch. When the tip cartilages are strong enough to make the tip wide-ish, and to make the tip sit a little low, they are also strong enough to hold the tip out away from the face. If we move the tip back closer to the face, then the position of the gentle hump on the bridge of the nose would look even bigger, so I reduced that some as well.
You should understand that the changes I demonstrated in the morph require advanced techniques, techniques that most plastic surgeons cannot handle.  Be sure to read the section in the "Web reference" link on how to stay out of trouble while searching for a rhinoplasty surgeon. You should only have surgery if you are able to make yourself very confident in your surgeon's skills.
I'd love to hear what you think of the morph. Did it seem to address your main concerns?
Your nose is also a good example of why computer imaging is mandatory in rhinoplasty. You need to know exactly what the surgeon is planning to accomplish -- what features he thinks he can change, and by how much he thinks he can change them. When you see his goals, you'll know whether he has an eye for a beautiful nose, and whether he shares your opinion of what constitutes a beautiful nose. You'll also know whether the changes he proposes are enough to be meaningful to you, and whether he understands your wishes enough to address all of your priorities. But remember, you're not hiring him for his skills with the computer. The doctor must then show you his before and after photos to prove that he can actually accomplish what he draws on the computer.
In your case in particular, you need to find a surgeon who understands all of the issues I mentioned -- the tip width, and tip length, and tip projection, and the height of the bridge -- and how they fit together, and who can actually accomplish them in surgery. You don't want to be looking for a revision later.
Finally, at the *very* bottom of the Web reference page is a link to instructions on taking photos that are more comprehensive and useful for online consultations like this, in case you'd like a more complete evaluation.

William Portuese, MD · Answer

When patients have a dorsal hump, and a wide bulbous tip, a full rhinoplasty is required. Most patients require a full rhinoplasty, not a tip rhinoplasty in order to make sure that all of the components of the nose balance with themselves, and the entire new nose balances with the patient's facial features. For many examples of full rhinoplasty with nasal bone osteotomiess, please see the link and the video below

Fred J. Bressler, MD, FACS · Answer

Thanks for your post and photo. In my view, you may not be the best candidate for tip rhinoplasty alone. Based on your image, your tip and nose demonstrate other concerns with tip support, overall nasal length and profile disproportion which would not be completely address via tip rhinoplasty. Natural, attractive results may require more than simply tip rhinoplasty. I would consult with an experienced rhinoplasty specialist for professional morphing, examination and recommendations regarding your interest in nasal improvement. Depending on your consultation and aesthetic goals, you may not require any osteotomies for your nasal bones. Discuss your wishes with a trusted professional and ask for an estimate of professional charges.

Arian Mowlavi, MD, FACS (license on probation) · Answer

Nasal tip can be improved isolated from the hump etc. can be done under local. However, remember that sometimes it is necessary to reinforce the nasal tip with a cartilage graft which must be taken from your septum; as well usually, some improvement of the middle and upper vault is also helpful. As such, I do not usually recommend nasal tip rhinoplasty under local. A consultation with a rhinoplasty specialist should be able to confirm your question.

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