Steps to Define a Nasal Tip During Rhinoplasty 

The most common surgical procedure I perform in my office in Charlotte is rhinoplasty.  A rhinoplasty is completed for a variety of concerns.  The goal of a rhinoplasty is to create a nose that blends with the face.  After a successful rhinoplasty, most patients are able to focus on their eyes and smile instead of the nasal region.  During a consultation, I will work with my patients on identifying the areas of the nose that do not fit the face.  After these areas are identified, I can create a procedure plan and hopefully a better version of the patient’s nose.  As a rhinoplasty expert, I believe this approach creates the most natural appearance and patients are happiest long term.

The tip of the nose is a common area that patients seek to refine or define during a rhinoplasty.  In this blog, I want to focus on the steps taken to make a bulbous or wide nasal tip smaller and more defined after a rhinoplasty or nose job.

The Anatomy of Wide Nasal Tip

To be able to understand the steps to improve a wide nasal tip, I want to explain its many causes.  The nasal tip is composed of:

• Nasal Skin
• Nasal Cartilages

There is great variety in the quality and thickness of nasal skin.  The nasal skin can range from thin, dry to thick, oily, and sebaceous.  Think nasal skin will add volume to the nasal tip contributing to its increased size.

The shape of the tip of the nose is formed by the size, shape, and orientation of a paired set of cartilages, the lower lateral nasal cartilages.  There is a specific size, shape, and orientation of the cartilages to create a refined nasal tip.  If any of these qualities are not aligned, it can create a wide nasal tip.

Step 1 of Defining Nasal Tip – The Rhinoplasty Consultation and Examination

During a consultation in Charlotte, I will closely examine the anatomy of the nasal tip and explain to the patient the cause of the wide nasal tip.  I will closely look at the nasal skin and the characteristics of the nasal tip that will give me clues on the size, shape and orientation of the nasal cartilages.  As a rhinoplasty surgeon, I know that the only way to truly know the characteristics of the nasal tip is visualization during surgery.

Step 2 of Making Nasal Tip Smaller- Thin the Skin

If patients have thick nasal skin, then I will thin it during a rhinoplasty.  This is commonly performed during African American rhinoplasty and patients that have sebaceous skin.

Step 3 of Refining the Nasal Skin- Remove Nasal Tip Cartilage

There are patients that the nasal cartilages are overly wide.  In this instance, the nasal cartilages will be conservatively thinned.  This is called a cephalic trim.   In this instance, I always leave at least 7mm of native cartilage in the nose.

Step 4 of Making a Smaller Nasal Tip- Improve the Orientation of the Nasal Cartilages

The ideal orientation of the nasal cartilages is:

• Relatively flat in the nostril region
• Oriented towards the lateral corner of the eye
• Angular at the tip region

If the cartilage is overly curved in the nostril region, I will flatten it with cartilage grafting or suturing techniques.  The cartilage grafting most commonly used to flatten the cartilage is called lateral crural strut grafts.   If the cartilage is not angled correctly, I will move the cartilages in a better orientation.  Medically, this is referred to as a correction of cephalically oriented lower lateral crura.  To help the angulations at the tip, I commonly place sutures in the region.

Step 5 of Refining the Nasal Tip- Make the Nose “Larger”

The size of the nose from the profile can have a profound effect on the appearance of the nasal tip.  This is especially true for patients that have thick skin.  If patients have thick skin, it is imperative to “push out” the nose from the face.  I like to use a tent as an example.  If you look at a tent from the sky, and you make the tent taller, it will look pointier.  If you make the tent shorter, then the tent will look less pointy from the sky.  The nose with thick skin works the same way.  During a rhinoplasty, I will make the nose taller (come out more from the face) to create more definition in the nose.

It is important after surgery to actively monitor the healing process of the nose.  I want to ensure the nose is not creating scar tissue that may limit the creation of definition in the nose.  If I feel the nose is creating scar tissue, I will inject it with medication to prevent further development of scar tissue.

There are many steps that I take to create definition and refinement to the nasal tip during a rhinoplasty in my practice in Charlotte.  I hope this blog helped you understand some of the steps I use during surgery.  If you have further questions or would like to have a consultation, please call (704) 842-3644 or fill out the online contact form.