Surgery of the Nasal Tip
The nasal tip is composed of cartilage and ligaments that form a semi-rigid structural unit. In many patients, this structural unit is weak and requires reinforcement. In patients who have thick skin or a drooping tip, it is likely that the tip needs to be strengthened during surgery. A failure to provide this support can lead to undesired changes as the nose heals, even years following surgery. At times, patients will request small or subtle changes to their nasal tip, with no changes anywhere else on the nose. While this procedure may sound straightforward and simple, this is rarely the case with any nasal surgery. However, with these ‘tip rhinoplasties,’ the healing process is usually shorter with less swelling of the nose post-operatively. Surgery of the nasal tip is extremely complex, and is not easily summarized in a few short paragraphs. However, to summarize how I approach the tip, I view the tip in both a geometric and a topographic way. My approach is to build the tip complex and then to contour it. Building the tip helps stabilize it and set tip projection (essentially, the measurement from the face to the tip) and nasal length. Sculpting the tip is more artistic and requires an ‘aesthetic eye.’ This step involves small grafts and sutures to produce a width and shape to the tip that makes it appear natural. As with every area in rhinoplasty, I approach each tip individually. Much of my customized approach to rhinoplasty involves producing a tip that ‘fits’ the patient’s face and one that they desire. As with everything in rhinoplasty, communication between surgeon and patient is the key to success.
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While many patients who seek rhinoplasty direct their focus to the dorsum and profile view of the nose, most patients will benefit from some refinement of their nasal tip. In my approach to rhinoplastly, I recognize that importance of producing a natural tip that balances well with the rest of the nose. It is certainly true that the key to a good rhinoplasty result lies in the tip.
