Make my Nasal Tip Smaller!–Common Rhinoplasty (nosejob) concerns

Narasimhan Plastic Surgery

In this blog, I would like to discuss some of the most common cosmetic concerns my patients have during their consultation for rhinoplasty (nosejob or nasal reshaping).  What are some common features, and how do we treat them?  My job as a board-certified plastic surgeon and rhinoplasty specialist is to translate a patient’s concerns into an effective surgical plan.

“Make My Tip Smaller”

Having a large nasal tip can be due to several reasons depending on the patient.  Firstly, it can be due to the size of the nasal cartilages.  In this situation, we would shave the cartilages and use suturing techniques to make the tip smaller.  However, this may not always been the case.  In patients of different ethnicity such as African Americans, the issue is actually the thickness of the skin.  I tell many of my patients of African descent that the nasal tip is not actually large, it’s more that the tip skin is thick!  In the situations we need to thin the skin to remove volume.  Also in African and Asian patients we do use cartilage, especially rib cartilage to provide structure to the nasal tip.  In this case surgically it is actually opposite of how I treat patients of Caucasian descent.

Examples of Reduction of Tip Procedures in two different patients (below)

Rhinoplasty before and after photos front viewRhinoplasty before and after photos front view


“I Don’t Like the Bump on my Nose”

This is probably the most common complaint of patients who desire a rhinoplasty procedure.  The bump can be large due to fullness in the bone or the cartilage of the nose.  Most commonly, I sahve or file down this area using a rasp or a blade to remove the excess.  This leaves a nice smooth nasal profile, especially on the side view.  Many female patients prefer a slight concavity to the nose with a slight curvature.  This makes the nose more feminine.

Hump removal with shaving of both bone and cartilage (below)

Rhinoplasty before and after photos profile view

“My tip points down when I smile”

All of us have a muscle call the depressor septi.   This muscle pulls the nose down when we smile.  In addition, other patients have ptotic tip or dropping.  This means that the tip points downward due to structural differences in the nasal cartilage.  It could be the nasal septum, or the tip cartilages.  In this situation, we would remove the excess septal cartilage and reposition the tip cartilages.  Also, release or division of the muscle helps with the tip at points downward.  Many female patients, especially, like a nose that rotates upwards with a slight angle.  This softens the facial profile and makes her nose look more feminine and gentle.  However, many men also would like a nose that does not point downwards in profile view.

Example of improvement of Ptotic Tip during smiling seen on profile (side) view (below)

Rhinoplasty before and after photos profile view

“My nostrils show too much”

Nostril show is a cosmetic concern expressed by many patients.  This is caused by either a hanging columella, in which the cartilage in the columella or base of the nose is excess.  There may be also weak structural support of the skin and mucosa.  Other patients have week cartilaginous structure in this area.  In these patients septal cartilage is used to restructure the area.  This concern is a complex issue and is individualized based on patient anatomy.


While the complaints may be the same, the structural differences are many!  Patients prefer a rhinoplasty specialist for their procedure.  Dr. Narasimhan is board-certified in plastic surgery and otolaryngology (ear, nose and throat surgery).  He has extensive training and rhinoplasty and facial plastic surgery procedures.  He is conveniently located in the Gateway region of Tampa Bay.  His office is very close to Tampa, St. Petersburg, Clearwater, and surrounding communities.  Call us for consultation today and check out our photo gallery.

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