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.
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.