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Tip Rhinoplasty Refinement

Crooked Tip Rhinoplasty

This is a great example of how cosmetic nose job surgery can help correct a crooked nasal tip. This type of cosmetic nose deformity is also commonly referred to as the following:

  • Displaced nasal tip
  • Deviated nasal tip
  • Twisted nasal tip
  • Asymmetrical nasal tip tip

No matter how you label it, this is the type of nose deformity that can be quite obvious when looking at someone from the front view. As you can see here in her preoperative photo, her nasal tip is, indeed, quite displaced off to her right side. The black vertical line corresponds roughly to the middle of her face. It extends from the glabella down to the philtrum of her lip. The long axis of the nose should ideally approximate this line.

In this particular case, her upper bridge (the nasal bone or nasal pyramid) is fairly straight – although the nasal bone on her left side was lateralized a bit. But as the nose extends toward the nasal tip you can really see how it deviates off to her right side. In fact, if you look closely you can appreciate how most of her nasal tip is off center and to her right side.

Perhaps more than any other type of nasal tip deformity – including a bulbous nasal tip, a squared nasal tip, a wide nasal tip, and even an upturned nasal tip – an asymmetrical or displaced nasal tip can be really distracting to look at from the frontal view. This is precisely why patients like her seek out rhinoplasty experts like Dr. Hilinski to help straighten their nose out.

Nasal Tip Reshaping

In addition to her displaced nasal tip, this patient also had a somewhat heavy columella that was best seen on her side view. The red arrow points to the precise location of the columella – the column of soft tissue that sits between the two nostrils.

In cases where the columella is a bit prominent, you can see it on the side view as being a bit ‘heavy’ in its appearance – meaning it hangs down slightly. This is not too surprising given the issue she had with a displaced nasal tip – since the support of the nasal tip is intimately involved with the underlying shape and position of the nasal columella.

But this is seen in combination with a nasal tip that is a bit bulky overall. So in the process of trying to make her nasal tip straighter, the goal was to also give her nasal tip a bit more of a feminine look – without making it look fake or artificial.

Open Tip Rhinoplasty

In order to accomplish the desired changes to the shape of her nose, Dr. Hilinski performed an open rhinoplasty approach to fully expose the cartilage framework of her nose. The type of changes that were made are shown here in the adjacent intraoperative rhinoplasty diagram. Much of this is may not make sense to most rhinoplasty patients. But it shows diagrammatically how Dr. Hilinski reshaped the nose. This included the following rhinoplasty maneuvers:

  • Breaking of her left nasal bone in isolation
  • Septoplasty cartilage harvesting
  • Placement of a left splinting spreader graft
  • Movement of the medial crural footplates
  • Placement of a left columella strut graft
  • Ancillary cartilage grafting of the alar rim

Could this rhinoplasty have been done with a closed technique where no scars are made on the outside of the nose? Probably not in our opinion. That is primarily because of the spreader grafting that was needed to help splint her nasal tip more toward the midline or middle of her face. Such a change would have been incredibly challenging using a closed rhinoplasty approach.

Beautiful Rhinoplasty Results

Here are the beautiful results Dr. Hilinski was able to achieve in this particular case. How amazing is it to see her nose now in the middle of her face! This is actually one of the most difficult things to do in the world of rhinoplasty – but something that Dr. Hilinski does time and time again for his wonderful patients. On the 45 degree angle view and side view of the nose, you can also readily see how the shape of the nose has been improved to give a much better cosmetic appearance. This includes lifting of the columella to give her a bit more of a feminine shape and look. Yet – overall her nose still appears very natural looking – as if she could have been born this way! Plus, her new nose now functions much better than her old one – a huge added bonus to undergoing surgery by Dr. Hilinski.

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