Nose Tip Refinement (Nasal Tip Rhinoplasty)
Nasal tip rhinoplasty refers to any procedure performed on the lower third of the nose. Nose tip refinement is a delicate art. It requires a lot of skill and experience, as well as a thorough knowledge and appreciation of the structure of the nose and how cartilage and other tissue lends itself to the refinement process. “Success in nose tip refinement depends on the technique as well as the choice and quality of cartilage grafts used, if any are needed,” says Dr Marcells.
The method used for refining the nasal tip depends on the issue needing correction.
Wide tip correction
A wide or bulbous tip of the nose is usually the combined result of thick skin on the nose and large nasal domes that are widely spaced. The nasal domes refer to the tip defining points of the tip cartilage. The nasal domes are in many cases separated by a thick ligament or by fat. If this is the case, working on the soft tissue and moving the domes together is necessary.
“In those who have thick skin, I use a graft on the very tip of the nose. This will give the nose tip better definition.”
Shaving off or tweaking the cartilage structure underneath the skin can also narrow the tip of the nose.
Treating an over projected nose
For those whose noses are over projected—sticking too far out from their face—the correction involves trimming or cutting of the nasal cartilage at the tip. This procedure, which moves the tip of the nose back to give a more pleasing profile, is sometimes called nasal de-projection or retro-displacement.
Correcting an under projected nose
Re-projection of an under projected nose tip requires extending the nose cartilage. This can be achieved in two ways depending on how the nose is structured. One method is by cutting the nose cartilage and sewing it up again to achieve a better projection position.
Adding a cartilage graft taken from another part of the body where there is plenty of cartilage is the second option for improving projection. In primary rhinoplasty, the cartilage graft is usually taken from the nasal septum itself. Cartilage can also be taken from the ear or from the ribs for the same purpose.
Types of cartilage grafts
Cartilage grafts, depending on where and how they are used, may be called columellar struts used to support the collumella, which divides the nostrils.
In revision rhinoplasty there may not be enough septum cartilage to use. In this case it is common to use bone from the rib cage for the cartilage graft.
Traditionally, the cartilage from the nasal septum—the wall that separates the two sides of the nose—was considered the best source for a cartilage graft. Septal cartilage has been valued for its rigidity as well as its straight shape.
Cartilage from the ear, or conchal cartilage, is in relatively limited supply and is thicker and much more elastic compared to septal cartilage. It is also curvy. The elasticity of ear cartilage is considered an advantage in providing support to the nose tip. A typical cartilage transplant from the ear will be thicker compared to septal cartilage, especially if it becomes necessary to suture two pieces together in order to straighten them. However, the result will be a more natural feeling nose tip, rather than a rigid and solid one, due to the elasticity.
Costal or rib cartilage has traditionally been considered the third option when cartilage is needed for primary rhinoplasty. Mostly, nose tip refinement is achieved with septal or ear cartilage rather than cartilage extracted from the ribs.
Dr Marcells, who is skilled and experienced at the rhinoplasty procedure, prefers to use costal cartilage for nasal tip refinement. He is one of few surgeons who perform this procedure and uses special techniques to ensure excellent long-term outcomes in tip refinement operations. Dr Marcells says that knowing the possibility of excellent results with tip cartilage makes it worthwhile for he and his patients to opt for that additional cartilage harvesting procedure. With his years of experience in facial plastic surgery together with his surgical skill, Dr Marcells is confident that his patients are not facing any additional risk during the rib cartilage extraction process. The resulting minimal pain can be managed with a course of pain medications.
For more information
Check out the Nose Gallery on this website for an idea of what is possible with nose tip refinement.
If you need more information about nose tip refinement rhinoplasty or wish to make an appointment with Dr Marcells, please contact us on 1300 555 095, email or using the ‘book consultation’ feature of this website.
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Meet Dr Marcells
MBBS (Syd), FRACS (ORL-HNS)
Past President – Australasian Academy of Facial Plastic Surgeons
Dr George Marcells is known for excellence in facial plastic surgery and is considered a true master of rhinoplasty. He performs advanced surgical techniques to restore balance and harmony to the face and can also resolve functional issues such as breathing difficulties.