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This 40 year old Virginia Beach woman came to me for a consultation because she wanted the bridge of her nose built up and a narrower tip. After looking at her photos together, we had a very detailed discussion about all aspects of her nose in relation to her concerns.  We agreed that the tip of her nose was turned upward and it would be more attractive and appropriate with more length.  I pointed out how her midface or upper jaw was set back, or lacked projection, leading to the appearance her entire nose was set back as well.  Using video imaging, I was able to give her an idea of what we could accomplish with surgery.  To build up her nose, we began with a peri-pyriform implant which is silicone that sits on the upper jaw so the entire nose can rest in a more normal position.  From this foundation, her own rib cartilage was used to bring the tip out and also lengthen her nose.  There is no other reliable way to lengthen a nose, or in other words tilt the tip down and project it at the same time with narrowing, other than using one’s own rib cartilage.  Especially in Asians, the septal cartilage and ear cartilage are far inferior and are not adequate to accomplish these changes.  Finally, with the tip projected out and the nose lengthened, I chose a reliable way to raise the bridge of the nose with “diced wrapped cartilage”.  This is taking rib cartilage and dicing it very finely, to less than 1 mm.  It is then wrapped in the patient’s own thin film of temporalis fascia tissue and placed on top of the bridge for a very smooth contour, creating significant augmentation.  She is extremely pleased with the refined proportions to her face and all the new, natural appearing features.  These techniques are some of the more advanced and difficult in modern rhinoplasty.  It takes a surgeon years of experience to become comfortable with these methods.  Dr. Hubbard has been using rib cartilage for over 20 years and wrote a major rhinoplasty textbook chapter on methods to control the tip with cartilage grafting. 

Surgeon: Dr. Thomas Hubbard

Case Number: 461

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*The persons shown in photographs on this website are stock photography models and are not actual patients of Hubbard Plastic Surgery & Skin Enhancement.

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Practice Policy Update Regarding COVID-19 View Update Online Consultation

Practice Policy Update Regarding COVID-19

We are excited to announce our reopening as of May 1st. While many things have changed, one thing has remained the same: Our commitment to your safety.

Consultations are available in our office and we will continue to offer Virtual Consultations as well. You will be asked to complete your registration paperwork in our secure patient portal prior to your appointment and your consultation fee will be collected by phone to minimize contact.

Here are a few changes we have made as we transition to this new era:

  • Please reschedule your appointment if you are not feeling well, have a fever, have been exposed to anyone with Covid-19 or travelled internationally within the last month.
  • We will limit the number of people in the building and waiting area to maintain social distancing and our staff will be wearing masks until restrictions are eased.
  • Please wear a mask during your visit but do not wear gloves. You will be given hand sanitizer.

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