Rhinoplasty Surgery for Nasal Tip Refinement

Rhinoplasty or “nose job” involves improving the nose’s appearance.  This is one of the most challenging in facial cosmetic surgery because it combines science, because the result should be “structurally sound,” and art, since the outcome should be pleasing to the eyes.

Nasal tip refinement is probably the most challenging part of rhinoplasty surgery.  First and foremost, the result is not only dictated by the plastic surgeon’s skill but also by the underlying features of the nose. 

In fact, about 95 percent of the nasal tip refinement result is achieved by changing the tip cartilages which are the flexible tissue, while the remaining is dependent on how the plastic surgeons will manipulate the skin and other tissues.

There are many available techniques to change the tip of the nose because each person has a unique nasal structure in addition to different goals and expectations of every patient.

But regardless of what technique is used, most plastic surgeons remove only a small amount of cartilage so the nasal tip will not collapse as the patients grow older; this method is also ideal because it can give a long-lasting result and structurally sound changes in the nose.  This is quite different from the approach used 20 years ago in which doctors removed more cartilage to refine the tip.

For patients with a wide or bulbous nasal tip, the problem is generally caused by the widely splayed cartilages.  To treat this aesthetic problem, some doctors recommend suturing technique which often leads to lasting result if properly conducted, although patients should remember that there is always the probability of future revisions due to unexpected changes in the nose cause by aging and other factors.

As mentioned earlier, the result of rhinoplasty is largely affected by the nasal structure, particularly the skin thickness.  Doctors have found out that African-Americans have thick skin but weak underlying cartilages—ethnic features which must be respected to create the most natural result possible. 

On the other hand, Caucasian nose typically has thin skin and strong cartilages.  With this consideration, certain synthetic implants such as silicone plastic is not ideal for patients with this nose because of the higher risk of visibility.

When treating the Caucasian nose to reduce the nasal tip’s projection, it has almost been a sacrosanct among plastic surgeons to simply rearrange or remove a small amount of cartilage instead of introducing synthetic implants (although there is some exception to the rule).