Before (left), after (right). A wide bridge and an asymmetric tip. Rhinoplasty narrowed the bridge and refined the tip to balance with the rest of the face, with a natural, unoperated look.
This case combined a bulbous, under-projected tip with a wide lower third and a thicker skin envelope, so the plan worked on the tip and its foundation together. A cephalic trim of the lower lateral cartilages reduced supratip bulk, and firm transdomal and interdomal sutures narrowed the domal angle into clear tip-defining points. A thicker skin envelope pulls harder against a new tip shape, so a rigid columellar strut, or a septal extension graft where more length was needed, anchored the medial crura to hold the projection. The alar base was narrowed with wedge and sill excisions to match the refined tip, and the bony vault was narrowed with lateral osteotomies, with spreader support to protect the airway and keep the brow-tip line smooth. Dr. Khaled Ghalwash, Alexandria.
