A fat or wide tip of the nose is another of the top reasons patients seek corrective rhinoplasty. The tip of the nose, or the lower third of the nose, is one of the most distinguishing features of someone’s face. It is probably what makes everyone’s nose really different. Few nasal tips are exactly alike. Some are fine and narrow, others are wide and thick, and many are in between. How the roll or scroll of the cartilages of the lower nose come together makes for how the shape of the nasal tip looks. The joining of these two strips of cartilage comes to a peak at the tip of the nose. How wide these strips of cartilage are and how close or far apart they meet go a long way in shaping the tip.
Many patients talk about just wanting the ‘tip tweaked’. This usually means having the tip narrowed and/or lifted a bit. Bringing the cartilages closer together with sutures helps narrow the tip. Lifting the tip comes from narrowing those same cartilages on their upper edges. (and reducing the length of the septum) These two maneuvers are often done together to create the nose tip tweaking effect. You can see that combining all of these tip techniques is a bit of an art form. How much to remove? How much to tighten? It is not an exact science.
Sometimes the tip of the nose is too long. Bringing it up may make it appear shorter but often the tip cartilages are just too long. This requires trimming the length of the tip or shortening the legs of the tip cartilages so it s visible length is shorter. Again, another possible tip maneuver that needs to be considered.
Because of the complexity of the shape of the tip of the nose and the many different changes that can be done (often all are needed in the same patient), this is why tip manipulations are the most demanding in rhinoplasty surgery. And also why the tip area is the most prone to postoperative deformity and need for secondary revision.
You can make all the right changes in the tip area and still not have a good result…because the skin overlying the tip does not adapt well after surgery. Hence the reason for placing tapes across and around the nasal tip after surgery. To squeeze the skin down to the new shape of the tip and try and prevent excessive scarring to develop between the skin and the cartilages which can partially camouflage all of the nice changes to the tip which were done.
Dr. Barry Eppley
Indianapolis, Indiana