It is a very common complaint that people do not like the shape of the tip of the nose. It’s usually a matter of being too thick and full … or just too fat. Patients often want a slimmer, more refined look at the tip of the nose. They may be happy with the rest, but it is the shape of the tip that bothers them the most. Or, there may also be other problems with the shape of the nose (bulge or hump, for example) that they would like to improve at the same time.
The tip may be the smallest surface area of the nose per surface area, but its anatomy is the most complex. Its shape and angulation with the bridge over it and the lip underneath has a profound impact on how the rest of the face looks. It is probably the only feature of the nose that is most uniquely different from person to person.
The change of the tip of the nose, known as a tip rhinoplasty, can be performed alone or as part of a more complete rhinoplasty. The operation is a variety of surgical maneuvers aimed at changing the size, angle, or height of the nasal tip. Sometimes a few well-placed sutures are all that is needed, other times the cartilage must be removed and a more complex reshaping performed. Many different changes in tip shape are possible and the end result is only limited by the thickness of the overlying skin of the nose.
From an anatomical point of view, a tip rhinoplasty changes the relationship of the lower lateral wing cartilages with the upper lateral cartilages and the end) of the nasal septum. In addition, the size of the lower wing cartilages and how they join in the middle is always altered. Common surgical techniques, such as cephalic cutting, dome suture, caudal septum reduction, columellar strut graft, and cartilage tip graft, are helpful in narrowing, rotating, and supporting the new nasal tip. The confluence of all of these methods, and more of those not mentioned, make tip rhinoplasty the most complex region of the nose to change. More can be done in this small area than in any other area of a rhinoplasty procedure.
Usually when a patient refers to pinching the nose, they are usually referring to making it a little narrower (more refined) or lifting it a bit … or both narrowing it and a small elevation combined. These changes can be made using an open or closed approach. When the changes are small, I prefer a closed or endonasal approach to decrease the time the nose remains swollen after rhinoplasty surgery.
When modifying the tip of the nose, it is essential not to ‘modify it too much’. This means not turning the tip into a single point (too narrow) or lifting it too high or short. When this happens, you will have an operated look that is synonymous with having your nose done … exactly what patients try to avoid.
