Most rhinoplasty results are going to be judged on how well the tip of the nose looks after. While tip manipulation is just one part of most rhinoplasties, it is the one part of the nose that draws the most attention for most patients. And it is the one part of the nose that can be felt the most because it sticks out further than any other facial feature.
Nasal tip problems are usually a combination of lack of definition (too wide) and inadequate projection. (doesn’t stick up enough) Often both nasal tip problems co-exist. The shape of the tip of the nose is primarily controlled by the size and shape of the lower nose cartilages (the scrolls) and how they come together to create the dome. (what patients would call the actual tip) There are relatively precise and well-defined geometric relationships of the tip of the nose, such as the nasolabial angle (90 to 110 degrees) and the width of the space between the nose tip cartilages. (4mms or so) Suffice it to say, however, that changing the nasal tip cartilages is realistically about improving what is already there and getting closer to these anthropometric goals, rather than achieving a result that can be mathematically measured. The closer the rhinoplasty result comes to these measured values, the better the result will be to the patient.
Because such precision in nose tip surgery is so desireable, and there is little room for error in the most visible part of the nose, the open approach is how most rhinoplasties surgeries are performed today. There are very few plastic surgeons that can achieve in a closed rhinoplasty what can be done in the ore visible open rhinoplasty. The very small columellar (strip of skin between the nostrils) scar that results and a longer period of tip swelling after surgery are but a small price to pay for improved anatomical rearrangement and better long-term results.
Most nasal tip cartilage manipulations today are about preservation and rearrangement, not just removal of cartilage. Of the many very useful tip cartilage shaping manuevers, only one (cephalic trim) to make the nose less full on top) is about removing any cartilage. The rest are about reshaping through sutures or the addition of cartilages. (e.g., columellar strut) So when your plastic surgeon talks about taking cartilage to help reshape your nose, it highly suggests the he/she is very contemporary on rhinoplasty surgery.
Dr. Barry Eppley
Indianapolis, Indiana