Why nose tip drops after rhinoplasty surgery?
Sometimes patients are disappointed after rhinoplasty, or
nose surgery, because various changes can evolve
negatively in the postoperative period. One of the more
common effects is the so-called “dropped tip.”
Here’s what that means. Initially, when seen from the side,
the profile view, the tip sits at a desirable level in relation
to the rest of the nose’s profile. But with time, the tip
actually settles down, drops and gives a round or convex
appearance to the front half of the profile. It may look like
a new bump has formed.
There are several reasons why this happens. In most
cases, such a drop is predictable — and preventable. The
first reason is that the surgeon fails to allow for an
anticipated drop and, therefore, incorrectly sets the tip
position in reference to the rest of the nasal profile
including the bridge. It is well-known among experienced
nasal surgeons that there will always be some downward
contraction of the tip owing to the fact that their incisions
tend to contract. The natural downward pull of gravity and
contractile forces from those incisions will tend to make the
tip drop. The surgeon must anticipate that during the
planning of your operation and during its execution.
The second common reason for the tip dropping is that
there is not enough strength in the remaining tip cartilage
to maintain its position. If the surgeon fails to recognize
that the tip cartilage is weak and will not hold its posture
after part of it has been removed to narrow the lower half
of the nose, then such a dropped tip will occur and the
profile will be imperfect. An assessment of the prospects of
that happening should take place at the consultation as the
surgeon feels the strength of the nasal cartilages and
makes an estimate as to what percentage of the strength
can be maintained after a portion of the cartilage is
removed.
Here is the analogy in architecture and construction: If you
weaken a load-bearing support wall too much, the roof will
sag or come tumbling down.
Reason number three for the “dropped tip” is that, in fact,
the tip does not drop but the tissue of the nose above the
tip rises up and makes it look like the tip has dropped. This
is generally due to the surgeon’s failure to anticipate the
contraction and tightening that will certainly take place
during healing. As swelling diminishes and the tissues
begin to weld together, an upward elevation of the
cartilages in the midportion of the nose can occur. These
“upper lateral” cartilages automatically and naturally
migrate towards the middle and if they had not been
trimmed enough in anticipation of this migration, then they
tend to rise above the anticipated profile level. Thus, a
profile convexity occurs that makes the tip look as though
it has dropped. An illusion has been created.
Rhinoplasty is a complex operation which requires
imagination on the part of the surgeon, a working game
plan based on anticipated changes and, most importantly,
a knowledge of the consequences of each and every
surgical maneuver that takes place during the operation.
No wonder rhinoplasty holds its reputation as the most
difficult operation in the world of cosmetic plastic surgery.
And, remember, not all plastic surgeons are equipped by
training, experience or talent to perform it.
Always look for a master of cosmetic nasal surgery, a
super-specialist. They will be more likely to create a
outcome that meets your expectations.
