Rhinoplasty and facelift operations continue to be my favorite operations. In rhinoplasty one of the more common maneuvers is to reduce the projection of the nasal tip. In this clinical scenario the tip of the nose has excess projection for one of two reasons, either the tip is extrinsically held out too far because of the nasal septum or the tip is intrinsically projected too far because the lower lateral cartilages of the nose are too large. On occasion, the tip of the nose can be over projected for both intrinsic and extrinsic reasons. When both extrinsic and intrinsic causes are over projecting the nose, there are additional maneuvers that need to be performed to make the nose smaller.
In a nose that has significant intrinsic cartilage projection, the lower lateral cartilages need to be overlapped at the lateral crura and then the medial crura need to be partially resected or set back to maintain a similar columella-labial angle. It is often important when making significant changes to the nose to maintain or keep certain characteristics of the patient’s nose if that is their desire. When the nose is de-projected proportionally, other people may not notice that a patient has had a surgery on their nose. This is excellent. Often patients may not want a significant change to the appearance of their nose, just a smaller version of their own nose.
When the tip is significantly reduced in the amount of projection, the nasal tip can be swollen for several months to one year. It is important for patients to know that improvement in the nasal tip can take one to two years to completely improve. During this time the patient will appreciate the improvement in the side profile of the nose, but may take several months to appreciate the improvment in the nasal tip and frontal appearance of the nose.