Dr. Sam Lam Plastic Surgery Forum

Tip plasty invoving

*making the tip sharper (By building or shaving off cartiladge on bulbuous noses)
* narrowing the alar base on patients with wide and flat nostrils
* creating a columella where there is technically none
* Correcting a weak tip that moves too much (especially in black and asian patients that have little tip support due to lack of strong cartilage and bone, instead having too much tissue and soft cartilage creating a bulbuous tip)

What's your approach? How would you go about surgically imroving these areas?

thanks

I have explained a lot of this in my Asian rhinoplasty consultation video. However, in summary, here are some problems and solutions:
1. As far as the nasal tip is concerned, I most often perform an onlay cartilage graft, as the thick skin will not show the graft over years time. I believe that thinning the cartilage in about 80% of Asians can lead to a more bulbous tipe.
2. If the tip is low and hanging, I will perform a dome binding suture but in a nose with wide nostriils, this can lead to too much nostril show.
3. If the columella is deficient and so is the nasal tip, I will use an extended shield graft with or without an onlay tip graft. The shield graft also provides more tip definition but I need to see where the columella is in relationship to the ala.
4. If the skin is very thick over the supratip region, I will thin it out and then inject 5-FU to keep the skin down followed by 2 to 3 months of taping at night, which is mandatory.
5. If the premaxilla is deficient and the lip configuration is retruded, then I will perform a premaxillary cartilage graft. I will only perform this if the lip during smiling shows a gummy smile. Otherwise, I risk having the lip overhang the teeth too much.
6. The alar base I will reduce through a separated Sheen and nasal sill reduction in order to maintain the natural curvature of the nostril which is absent in celebrities like Janet Jackson. I no longer practice suture cinching as I do not believe that works for long term holding.

That is basically it, as far as I can think of. Understand if you ask me a technical question, I have to use technical terms in my response, as it would take me 20 pages to try to explain what I mean by each term. However, you can read my glossary under the resources section of this website to understand some of these terms. Also, you can watch my lecture that I gave in Las Vegas last year under Video Lectures to reinforce these concepts.
best,
sml