It is possible to refine the tip of your nose a number of ways through the endonasal or “closed” rhinoplasty approach. In Asian rhinoplasty, a common complaint is that the tip of the nose is too round or bulbous, and that it is too short (underprojected). Part of this is due to the weakness of the cartilage that makes up the nose and part of this is due to the thickness of the overlying skin, which hides any the definition of the underlying cartilage.
Perhaps the best endonasal technique for refining the tip in Asian rhinoplasty is the use of multi-layered tip grafts. Multiple small pieces of cartilage can be sutured together to create a much thicker and more stable construct. A small pocket is then created along the tip of the nose, and the tip graft is placed into this pocket. When performed well, this graft will simultaneously project and refine the tip.
Although removing cartilage from the tip of the nose works well to add definition and refinement in patients with well-projected (tall) tips and medium to thin skin, this technique works poorly when the tip is under-projected (short) with thick skin. Suture techinques are possible to achieve greater definition and projection during Asian rhinoplasty. The tip cartilage (lower lateral cartilages) are brought closer together to create a more defined and taller tip. However, often this technique is not adequate. To achieve significant definition and refinement, structure and support must be added to the nose during rhinoplasty to ensure that what refinements and changes are made to the nose can show through thick skin.
