Nasal tip rhinoplasty refers to the shape and size of the bottom third of the nose, known as the nasal tip. A more conservative nasal tip rhinoplasty approach can permit correction only of the region of the nose that is a perceived concern. Refinement of the nasal tip, known as a tip-plasty, can change the appearance of an individual in subtle yet profoundly dramatic ways. Raising the angle of the nose gently, refining the width of the nose without overly doing so, and reducing some of the fullness of the nose are common objectives of this kind of nose reshaping.

Tip-plasty is aimed at changing the shape of the nasal tip to improve the appearance of the nose. A tip-plasty may be performed to reduce a large, square or bulbous nasal tip, to treat an upturned or sagging nasal tip, or just to refine the tip of the nose.

Tip-plasty is one of the most challenging aspects of nose surgery as disruption of the cartilage that supports the tip of the nose can cause the tip to collapse, rotate or lose projection.

The surgery includes realignment of alar cartilage by resection and suture, fibroareolar and subcutaneous tissue resection, tip graft, and columellar strut. The nasal tip is positioned high and elegant, methods such as cartilage suture, cartilage grafting and blocking up the nasal septum etc. are opted as decided by the surgeon. The ideal shape can be achieved only if the nose has the adequate length. Therefore, the operation of embedding the supporting platform is often included. The tips of nose are made high and straight by suturing cartilage, performing cartilage grafting on sutural cartilage or embedding allroderm. In order to support the structure, the process of embedding nasal septum is very important. The embedding of nasal septum can also optimize the angle shaped by lips and tips of nose, and enhance the effect of nose augmentation operation.

A round or bulbous nasal tip, is due to a well-developed and large cartilage at the nasal tip. This cartilage widens the tip of the nose and makes it less defined. This is corrected through a tip-plasty procedure that excises the excess cartilage at the tip of the nose to narrow it down and give it more definition. Tip-plasty also increases the projection of the nasal tip, something much needed in an Asian nose which is usually deficient in height at the nasal tip.

Question:
I’ve heard that tip plasty is very complicated because there are so many intricate things in the tip of the nose, is this true?

Answer:
Rhinoplasty is a complicated and intricate operation, it is true! The tip is one part of the rhinoplasty that can contribute to this.

One of the things that makes rhinoplasty an intricate and complicated procedure is the many variables. For instance, the tip cartilages of each patient may have different length, strength and shape, different curvatures, unique asymmetries, and so forth. The nasal bones of each patient may be of different lengths and thickness, and of different orientation. The skin thickness differs between patients. The upper cartilages of the nose may also vary. Other variables also exist.

Changing any aspect of the nasal anatomy can have a complex and cascading effect on other aspects of the nose. Rhinoplasty surgery is an art and a science. Like a chess master understanding the complex interactions of the pieces on a chess board, the surgeon must be able to understand the complex interactions of each patient’s nasal anatomy. Therefore, knowledge, experience and technical ability are important traits for a rhinoplasty surgeon.