We often see patients who have surgery by other doctors seeking revision rhinoplasty. It’s clear the best time for the best result in all procedures especially the nose is the first time. However, there are instances where revisions may be desired. The tip of the nose is defined by its most prominent points, in the distance between them. Within a range, it’s optimal to have those two points ideally located. These are called the tip defining points.
The distance from the tip to the cheek is tip projection it has within a range an ideal relationship to the profile. This tip to the cheek should be about two-thirds of the overall length of the nose. If the tip to cheek is excessive we call this excessive tip projection.
The tip forms an angle to the lip. The tip to lip angle. In a female ideally, this is around 100° give or take a few degrees. If this angle is less than 90° turn this a drooping tip. Tip projection and tip rotation as well as tip defining points are essential to achieving the best looking nose. The thicker the skin the more challenging the ability to achieve the best tip.
It takes years of experience in order to achieve mastery of the rhinoplasty technique especially with the use of grafts. There’s really no such thing as “little tweaks” with respect to rhinoplasty. In order to achieve the best result, all structural components must be addressed in a systematic and comprehensive fashion. I usually start with the tip and achieve the best possible projection, tip defining points, and tip to lip angle before proceeding to the remainder of the operation. I prefer the closed technique as it allows in my opinion the best moment to moment analysis of the result as it unfolds before my eyes.
In my opinion, there is limited value for fillers since they are temporary. But under certain circumstances reducing or improving small irregularities can be achieved with fillers. I find that rib grafting cartilage is a very useful tool in certain instances since structural support is essential to achieving the optimal result. Often times the patient’s own structure is lacking cartilage or bone, and therefore rib cartilage can be invaluable.