Nasal Tip / Nasal Hump FAQ

Q: Can excessive cartilage in the nasal tip be removed without breaking the nose?

A: If the nasal tip is the only area of concern, the procedure does not require "breaking the nose". Only the upper 1/3 of the nose is actual bone, the rest is cartilage. If the only thing you need is to reduce the tip, it might not be necessary to "break" the nasal bones.

However balance comes up as an issue and in these cases, the bones need to be addressed. "Breaking" the bones is really a precise and controlled procedure that takes about 2 minutes in an otherwise 2 hour procedure. With technology as advanced as it is, computer imaging can be you to illustrate potential changes. "Breaking" the bones does not cause the nose to be any less stable; it only means the bruising will last a few days longer but in turn, you will get a better result.

Q: Which dermal filler is best for nasal tip projection and what are the complications associated?

A: Fillers are suited best suited for nasal profile and not in the tip. Due to the tip of the nose being very sensitive, using any filler to increase tip projection can be hazardous. The filler may take on a ball like shape due to the difficulty in keeping in such a small area. Unlike in the dorsum (upper 2/3 of the nose) or in the radix (the root of the nose), injectable fillers cannot be molded as well in the tip. The skin surrounding the nasal tip is also thinner than in the upper part of the nose, so everything will show: good and bad.

The entire idea of a non-surgical rhinoplasty has very limited applications and several potential hazards. Other than minor upper profile changes, I feel that fillers should not be used in the nose.

Q: How much bruising can I expect with a nasal tip procedure?

A: Tip rhinoplasty alone can often be done with little to no bruising. Bruising usually occurs from removing a large hump or narrowing the upper third of the nose. If only the tip of the nose is being addressed, there is often little to no bruising.

However, in most cases, changing the tip changes the overall balance of the nose and face. For my patients, I like to use computer imaging to show them what they can expect with tip surgery alone versus a full rhinoplasty.

A word of caution: This is the nose that you will have for the rest of your life. A few more days of bruising is worth it if you get a better result.

Q: How do you correct a droopy, bulbous tip? Will reducing a bulbous nose tip make a dramatic difference?

A: A rhinoplasty is a very personal and intimate experience for the patient as well as the surgeon. There are several ways to reduce a bulbous tip and/or raise it. A surgical plan can be develop after a personal evaluation with a rhinoplasty specialist. The factors that play a role in the surgical plan include, but are not limited to, are:

• Skin Thickness
• Strength and Width of the Tip Cartilages
• Length of nasal septum
• Position of nasal tip cartilages

The most common procedures used to create a more defined tip are:

• Sutures
• Grafts
• Struts

An experience surgeon will be able to tailor a plan that will best suit you and your goals.

Most patients will look generally the same after a rhinoplasty. The procedure should refine and sculpt the nose, which in most cases, does not make a dramatic difference. Some instances call for radical changes; however they are not the norm. Most of my patients tell me that their friends and colleagues hardly even notice that they had a rhinoplasty. The best compliment I can ever get from patients is when during the post op they tell me that they saw an old friend who said "You look great! What did you do? Lose weight? Have a makeover? New hairdo?" A proper rhinoplasty should fit your face and not call attention to the nose.

Q: Is there an "exact" rhinoplasty procedure for round nose tip or a bulbous one?

A: Every surgical plan for a rhinoplasty patient should be individualized to fit their face and needs. An "exact" rhinoplasty procedure for a bulbous nasal tip does not exist. Most rhinoplasty procedures use a combination of excess cartilage removal, sutures to narrow the tip of the nose and grafts of your own cartilage. Evaluation of the size and strength of the cartilage as well as skin thickness needs to be done with every patient. A "cookie cutter nose" should be avoided and hopefully discarded by all surgeons. Performing the same exact procedure on different patients does not make sense and can lead to significantly different results.

Q: What can I do to reduce the roundness of my nose?

A: Nasal tips that are round or ball-like have 2 common causes:

• Large cartilage
• Thick skin

Luckily both can be addressed with nasal tip rhinoplasty. However, once the nasal tip is reduced, the rest of your nose tends to be out of balance. So, seeking out a rhinoplasty specialist is best. In my practice, I use computer imaging to demonstrate potential results to my patients.

Nasal Hump Reduction

Q: To reduce a hump on my nose, would an open or closed rhinoplasty be needed?

A: For a primary rhinoplasty, most changes can be done using either approach and will yield similar to the same results. Whether it is reducing a large hump on the nose, rotating a drooping nasal tip, narrowing a wide tip or even straightening a mildly crooked nose, a n endonasal or closed approach can be performed with the same accuracy as an open approach. The approach is primarily dependent on the surgeon and their experience. In my practice, I do 90% of my primary rhinoplasty procedures closed.

Q: Is nasal hump reduction a simple procedure and does it require "breaking" the nose?

A: Dr. William Wright, a highly respected rhinoplasty teacher, once said "performing a rhinoplasty is easy. Getting consistently good results however, is difficult."

Removing the hump is all you may need and/or want, but often time making one change leads to others because the overall balance of the face could be thrown off. For circumstances like these, I like to use computer imaging to determine if removing the hump is all that is really needed. Other areas of concern, such as the tip of the nose being a little wide or sticking out too far maybe be demonstrated with the computer imaging.

"Breaking" the nose is often necessary for removing a hump. Removing a hump is similar to removing the top of a pyramid. If you do not close down the walls properly, there is a chance an open roof deformity will form. "Breaking" the nose does not destabilize the nose, but it does close that gap and creates better results in most patients.

Q: Does having thin skin effect removing a hump on my nose?

A: Whether you have thin skin or thick skin, a rhinoplasty can yield excellent results with the right physician. In the case of a patient having thin skin, there are a number of techniques that can compensate when performing a rhinoplasty. Thin skin often shows every little irregularity that may occur. There are ways to camouflage this though, one is to cushion the skin with a very thin graft of what is called fascia to act like carpet padding. I suggest you see a specialist in rhinoplasty for an opinion on what is best for your nose.

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