Nose is located in the center of face, having important role in determining impression. Beautiful and balanced nose gives neat and sophisticate impression. Hence, impression can be altered quite dramatically with simple tip correction if the size and shape of nose tip does not match with ideal proportion of face. Pointy and refined nasal tip gives younger and more three dimensional appearance. At the same time, higher nasal tip makes protrusion in the lower part of the face to appear less distinctive, changing overall impression and facial ratio.
Tip plasty is to correct the size and shape of nasal tip,in such cases of the nasal tip is blunt and low, consisted with small alar cartilage and thick layer of skin around nasal tip. Tip plasty is recommended to short or low nose tip. Nasal tip plasty might be dealing with small portion of the face, but it is considered as the very core of nose surgery as tip plasty determines overall shape of nose, and for its complexity. Hence, it should be conducted with nose surgery specialist who has enormous experiences.
Ideal shape of the nose tip
The width of the nose tip is considered as ideal if it takes about 60% of the width of alar wings, and the four point forming diamond shape
If the length of the nose is considered as 1, the ideal height of the nose tip would be 0.67
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How to correct nose tip
It is important to have accurate diagnosis on proportion of face, shape of the nose, height of the nose based onpatient’s facial features. Receiving alar plasty will create balanced nose shape. When the rhinoplasty is combined with tip plasty, it can enhance satisfying results. Combined surgery methods can correct aquiline, deviated, short, long, bulbous nose.
Previously, L shaped silicone implant was widely used for the nasal bridge augmentation and nasal tip correction, however, it has caused many side effects such as the implant gets visible when skin gets thinner as getting old. Recently, rhinoplasty is performed with silicone and goretex and tip plasty is performed with autologous cartilage graft such as ear or septal cartilage that does not cause rejection reaction. Ear cartilage is widely used since it is similar with alar cartilage and scar on ear is not distinctive. Moreover, septal cartilage has advantage of heighten nasal tip with solid strut.
What is the nasolabial angle?
One of the significant results of the two-line rhinoplasty is that the surgery can improve the Nasolabial angle. The Nasolabial angle is the angle between the tip of the nose to the upper lip from the side view, placing an implant to lift the nose tip enlarges this angle making your mouth to appear less protruded. This is ideal for those who have a protruding mouth and thus having a small Nasolabial angle. Inversely if you have a large Nasolabial angle this can also be corrected.
Types of nasal tip plasty
Tip plasty can be divided into two cases, when nasal tip does not need major correction or when nasal tip requires major correction. When reconstruction of nasal tip does not require major correction, which inner structure of nasal tip is balanced and its strut is straight, simply grafting autologous cartilage will correct the nasal tip.
If there is wide interdomal distance and requires heightening the tip, and the columella strut is not supportive, surgery method gets much more complicated.
When interdomal suture cannot refine the nasal tip, complex surgery methods should be conducted to correct the nasal tip. The pair of Middle crus of alar cartilage will be sutured to concentrate them into center. Also, solid strut will be created using autologous cartilage graft with columella strut extension, septal extension graft, and alar derotation graft.
Below surgery methods are most common methods for the tip plasty.
01.nasal tip cartilage rearrangement
Nasal tip cartilage will be rearranged by heightening nasal tip, extending or reducing its length.
02.Autologous cartilage graft
Nasal tip can be corrected with autologous cartilage using ear or septal cartilage, such as septal extension graft and columella- strut extension.
03.Combined method
Various surgery methods are combined according to each patient’s nose shape and structures.
Types of nasal tip plasty
01. Put a special nursing tape on the nose to stable the cartilage.
02. Connect and suture the collected cartilage or artificial augmentation with nose tip.
03. Check the general image of the surgery area and suture the nasal alar.
04. Put a special nursing tape on the nose to stable the cartilage.
Post operation care
Possibility of bleeding for 1-2 days. Wipe with a soft tissue.
Blow nose gently.
Do not detach or cut gauze and bandage without doctor's consultation.
Apply an ice pack on the day of surgery and the day after to reduce the swelling.
Avoid drinking and smoking for a month after the surgery.
Avoid wearing glasses or sunglasses for a month after the surgery.
