Question: I have a nose that is too wide at the tip. I would like this reduced in size and I would also like the nose shortened. Do you use the open-tip technique with an incision across the columella? Is general anesthesia suggested or required?
Answer: There are a variety of techniques that can be employed to narrow a tip and adjust its projection and depending on your particular anatomy this may or may not be performed through an internal approach versus an external approach. It really depends on the surgeon’s comfort level, experience, and the patient’s particular anatomy. For most patients that have a bulbous tip and an overprojected nose I can perform the procedure through an internal approach and, therefore, not need the incision along the columella; however, if a patient has significant asymmetries to the tip or if there is a need for a significant number of cartilage grafts then more than likely I would recommend an external approach. Ultimately, rhinoplasty is highly customized and, therefore, I would have to evaluate your particular anatomy before I would be able to tell you whether or not I would recommend an internal or an external approach. Regarding anesthesia, I perform all of my rhinoplasties under general anesthesia as I have just found that it is easier for both the patient and me and with today’s advanced anesthetic techniques the risks are exceptionally low.