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Droopy Tip Virginia

  1. The position and shape of the nasal tip is determined by 3 factors:
  1. Skin:
    *  Thick vs Thin skin
  2. Intrinsic Nasal Tip:
    *  Shape and size of the Lower Lateral Cartilages (LLC)
  3. Extrinsic Nasal Tip Position:
    *  Size and shape of Caudal and Dorsam Septum at the Anterior Septal Angle.
    *  Size of Anterior Nasal Spine
  4. Support mechanisms
  5. Dynamic ptosis (droopy tip when smiling)

These factors contribute to the shape and character of the nasal tip.

Skin is the blanket that covers the bone and cartilages of the nose. The skin on the tip can be thin and reveal the shape of the Lower Lateral Cartilages or the nasal tip skin can be thick and completely hide the shape of the underlying cartilages. Ideally the nasal tip skin is medium thickness but “ideal” is rare and a skilled rhinoplasty specialist surgeon can and should work with the individual’s anatomy to create a pleasing and appealing nose.

The actual shape and size of the Lower Lateral Cartilages (LLC) determine a large part of the shape of the nasal tip. These cartilages are often modified through various rhinoplasty techniques and maneuvers to create a more cosmetic nose tip. However, these cartilages themselves sit on top of the underlying foundation of the nose: Septum and anterior nasal spine. Occasionally an unattractive tip may be due to the underlying septal framework and not the actual tip cartilages themselves. This is easy to miss by the novice plastic surgeon. Diagnosis of the nasal problem is the most crucial initial aspect of any nasal reshaping surgery.

The nasal tip needs to have proper structural integrity and support. A nose tip that is too pliable and easily “squishy” will droop more when smiling and will droop more over time as the patient gets older. Support can be added with sutures or grafts. Columellar strut grafts are very commonly used to support the nasal tip.

Dynamic ptosis or drooping of the nasal tip when speaking or smiling is commonly due to a weak tip support &/or strong septal muscles (depressor septi muscle ) pulling the nasal tip down in motion. Botox can temporarily relieve the action of the septal muscles and prevent dynamic ptosis (drooping) or the muscle can be cut surgically and then the tip supported with grafts to prevent the nose tip from dropping down.