I recently treated a young lady whose complaint was that her nose had a round, non-projecting tip. This is due to the shape and strength of the cartilage that makes up the tip. You can try to treat this by reshaping the existing cartilage in the tip, but this only provides a slight improvement. What is needed is to add cartilage to provide strength, support and projection to the tip. In this case I harvested some cartilage from the septum (the wall in the center of the nose that separates the right and left sides), and carved a strut for the tip and a "shield" graft. The strut was placed in the "columella" (little column), in the center of the nose that separates the nostrils. This provided support for the tip so it wouldn't collapse. The "shield" graft (see attached picture) provides shape and projection to the tip.
My young patient was seen on the 5th postoperative day and the small sutures in the columella were removed. The tip was slightly swollen but the new projection and shape were readily apparent. Pain was minimal. She is off to college in a few weeks with an enhanced self image.
All the Best,
Dr. Jabs
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