The tip is one of the most important aesthetic parts of your nose. In the middle of your face, it often defines the nose and sometimes the whole look of the face. If the tip is well proportioned and defined we don't notice it, as it blends so well with the other features that we focus on the individual's eyes.
But if the tip seems rounded, bulbous, or disproportionately large, it can distract from the eyes and make the nose seem undefined. While the tip is a frequent concern of San Francisco and Oakland rhinoplasty patients, it is also one of the most difficult areas to improve. It is particularly challenging to get a great result from the front, which is why you may notice that many before and after views from other surgeons show the profile or 3/4 views but not the frontal view.
There are several common complaints about the nasal tip including bulbous undefined tips, large tips, boxy or bifid tips, asymmetric tips, droopy and/or mobile tips. This page will give examples of before and after rhinoplasty images of patients with these nasal tip concerns. Request a consultation online or call us at (415) 445-9513 today.
Case 300 Non-Surgical Rhinoplasty
Background: This African American man, in his 20's, had long felt his nose distracted from the rest of his face. While he liked it's shape in general, he felt the bridge was underdeveloped, had a 'scooped out' appearance, and looked like a child's nose. He searched for a surgeon familiar with ethnic rhinoplasty. He liked Dr. Mabrie's videos and consulted with him in his San Francisco office about ...
Case 276 Non-Surgical Rhinoplasty
Background: This young woman from the East bay wanted to subtly change the look of her nose but was not wanting surgery. She consulted with Dr. Mabrie at his San Francisco office about Non Surgical Rhinoplasty. Dr. Mabrie's Assessment: "This case illustrates the importance of a smooth nasal contour. With Rhinoplasty surgery her nose would been reduced, breaking the bone and cutting the cartilage....
Case 261 Non-Surgical Rhinoplasty
Background: This East Bay woman long considered surgery to narrow her nostrils. She consulted with Dr. Mabrie at his San Francisco office regarding Surgical Rhinoplasty. Dr. Mabrie's Assessment: "I recommended Non-Surgical Rhinoplasty to augment the nasal bridge and tip, combined with an in office surgical nostril reduction." Procedure: She received 1syringe of Restylane to her nose tip and brid...
Case 227 Non-Surgical Rhinoplasty
Background: This east bay woman consulted with Dr. Mabrie in his San Francisco office about non-surgical Rhinoplasty. In general she was happy with the overall size and character of her nose, but wondered if some small improvements could be made. Her two main concerns: 1. She didn't want her nose to look "done". 2. She was afraid of needles! Dr. Mabrie's Assessment: “This ca...
Case 218 Non-Surgical Rhinoplasty
Background: This young lady was fairly happy with her nose, but felt it was a little round and a little undefined. She was interested in definite changes, but nothing too drastic. She searched online for a facial plastic surgeon specializing in non-surgical Rhinoplasty in San Francisco, found Dr. Mabrie's before and afters, and made a consultation. Dr. Mabrie's Assessment: This young woman was ve...
Case 208 Surgical Rhinoplasty
Background: This young San Francisco woman was interested in Rhinoplasty surgery. She chose Dr. Mabrie because of his experience with preserving ethnic characteristics and maintaining natural results. She wanted a softer nose, like her mother's, with better symmetry, a smaller tip, and a straighter profile. Lastly, when she smiled and said certain words, like, "no", her nasal tip...
Case 201 Surgical Rhinoplasty
Background: This woman had long considered Rhinoplasty surgery. Her nasal tip was full and similar in size and shape to the nose of her father. While she liked his nose on him, she wanted something softer and more feminine. After searching several plastic surgery websites of doctors in San Francisco, she found Dr. Mabrie and scheduled a consultation. Dr. Mabrie's Assessment: "This African America...
Case 195 Revision Rhinoplasty
Background: This young woman had a previous Rhinoplasty years ago that had given good results. Years later she started to see a change in those results. She came in to see Dr. Mabrie for a consult with specific goals in mind. 1. Narrow the nasal bridge. 2. Make the tip less round. 3. Smooth the contour of her nose. 4. Improve her profile. Dr. Mabrie’s Assessment: "After her initial Rh...
Case 169 Surgical Rhinoplasty
Background: This 24 year old African American woman consulted with Dr. Mabrie about Rhinoplasty in San Francisco to improve the appearance of her nose. She explained that she would like the bridge thinner and tip more detained to match her face. Dr. Mabrie's Assessment: "The nose actually has a nice size and shape to start. There is a small bump on profile and the tip could use some definition. T...
Case 120 Surgical Rhinoplasty
Background: This 21 year old Tourism student is of Spanish and Italian ethnic background. She had a history of trauma a few years ago during a water polo incident. Her concerns were to: 1. Primarily reduce the bump in her nasal dorsum, 2. Resolve her difficulty in breathing, 3. To smooth the lines in her nose, and 4. To maintain the look and character of her nose. Dr Mabrie&...
The tip shape is created by the underlying cartilages and the way they interact with the skin. Asymmetric tips occur when the shape of the two cartilages differs from the way the cartilages are positioned on the septum. Correcting an asymmetric tip may involve modifying the shape or position of the underlying cartilages.
Bulbous/ Undefined Tips
There are several reasons a nasal tip may seem broad, bulbous, or undefined, including the size or shape of the cartilages, the space between the two cartilages, or the firmness or softness of the cartilages. If the skin is thin to normal, the most common cause for a bulbous tip is the shape and size of the cartilages. There are two nasal cartilages which are c-shaped. At the apex, these cartilages press against the skin and form tip-defining points. Together the two tip-defining points constitute the tip. If the cartilages are far apart, the tip defining points are far and may make the nose appear broad, bifurcated or boxy.
If the cartilages are very soft and the skin is thick, the tip defining point may be hard to see, making the tip bulbous and large. In many of these cases the cartilages are brought together, but additionally a tip graft must be used to press against the skin and create a defined tip.
In general we prefer for nasal tips to point straight forward. It is less desirable for tips to appear rounded or to point downward from the profile view. Drooping tips are treated by strengthening the nasal cartilages, either using a strut graft or attaching the cartilages to the nasal septum.
Non-Surgical Treatment of the Nasal Tip
The nasal tip appearance may be altered non-surgically using dermafillers placed under the skin. Dermafillers are synthetically engineered FDA approved substances which are well accepted by the body. They last for 6-12 months, gradually turning into water and CO2 until they are completely absorbed by the body. Some dermafillers may be reversed by injection of another material.
Tip definition and tip asymmetry may be treated with injection of dermafillers.
While dermafillers may be FDA approved for use in the face and may be helpful for contouring in the nose, non-surgical rhinoplasty is not one of the FDA indications and is classified as an off-label use. There is a risk for infection and tissue injury. Dermafillers must be used carefully and preferably by a professional with a great deal of experience with either rhinoplasty surgery or dermafilller injection. Dr. Mabrie is certified both by the board of Facial Plastic Surgery and the board of Head and Neck Surgery. He performs aesthetic procedures exclusively on the face.
Pitfalls in Tip Surgery
Two of the methods used to modify nasal tip size and shape are reducing the size of the cartilages or suturing the domes together. While these methods are very effective, they can also result in an operated on or unnatural appearance after some rhinoplasties.
When reducing the cartilages, it is very important to preserve enough of the tip cartilages to support the overlying skin for many years after the surgery, even as scar tissue develops.
Sewing the cartilages together is a method which is particularly useful in boxy or bifurcated tips. If overdone, however, this technique can cause collapse of the cartilages and create a pinched appearance. Sometimes, instead of sewing the cartilages too close together, it's preferable to use grafts and sutures to change the shape of the cartilages, thereby avoiding collapse and the pinched look.