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Primary

The dorsum is wide and the tip is bulbous, almost “square” in shape. The aesthetic lines of the dorsum flare outward in a “parenthesis” pattern immediately below the root because the nasal bones are excessively wide. A depression is visible between the two tip cartilages (the domes). The profile is satisfactory, although weighed down by the size of the tip itself. In this case, the primary objective is to narrow both the dorsum—through multiple osteotomies (surgical fractures) of the nasal bones—and the tip, by resecting the excessive portions of the alar cartilages and reshaping the remaining segments. These are refinements of “precision work.”

The dorsal aesthetic lines were improved by narrowing both the dorsum and the tip.
The tip was triangularized by appropriately reshaping the cartilages. The columellar incision is practically invisible.
In the three-quarter view, the proportions among the radix, dorsum, and tip have been improved. The depression between the tip cartilages has been corrected. After removing the excessive portions of the tip cartilages and refining the remaining segments with sutures, the very elements that had been resected were repurposed as grafts to recreate a harmonious tip.
The profile was refined through a slight lowering of the dorsum and reshaping of the tip. Preoperatively, the profile originated at the lash line, traveled straight, and then descended into a somewhat bulbous tip. Postoperatively, the profile is instead positioned just slightly lower than the line connecting the radix with the point of maximal tip projection.
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