The nasal tip represents one of the most important aspects of change in rhinoplasty. It is said that he who masters the nasal tip masters the nose. So what makes transforming the nasal tip such a difficult endeavor?
The nasal tip is composed of lower lateral cartilages. These cartilages can take a variety of nasal shapes, which includes convexity, concavity and excessive fullness. The bulbous nasal tip can be one of the more difficult endeavors because it requires appropriate diagnosis of the root cause of bulbosity or fullness of the nasal tip.
Causes of the bulbous nasal tip:
- excessively thick nasal skin
- excessively convex nasal tip cartilages
- too much cartilage along nasal tip
Changing the shape of the nasal tip is often described in the rhinoplasty literature in terms of 2d terminology. This includes such descriptors as projection, nasal tip rotation, length of nose, etc. The problem with this terminology is that it does not accurately describe what the patient may or may not like about his or her nose.
The nose is best described and seen in three dimensions. Three dimensional intrepretation of the nose is how we see our noses in real life and how we see others.
Photographs do play a role in describing the nose, but they do not do it as well as how we look in person. As is the case, sometimes a patient will note how his/her nose may not be photogenic with some cameras. The reason for this may have more to do with light, shadowing, and lens distortion than it does of an actual interpretation of the nose. A cell phone camera lens will not accurately depict a nose. This is why standardized photographs play such an important role in looking at nose and nasal anatomy.
So if seeing the nose in 3 dimensions is the best way to see the nose, how does one see the nose. This requires a vision of the nose to help reshape the size AND shape of the nose so that the appearance of the nose can be altered.
Nasal tip bulbosity as a result of thick skin will often require projection of the nose. This is to have the nose stick out further. While some patients may not desire a more projected nose, it may be the best option for patients with thicker skin.
Patients with convex cartilage will require a complex reshaping of the nasal tip cartilage. Dr. Shah uses a series of specialized techniques not described in the medical literature to help reshape the nose.