For patients with widely splayed and weak lower lateral cartilages, the nose tip has poor support. Performing simple tip onlay grafting on to this will create sub-optimal results. The heavy nasal tip will droop in the absence of structure and it will not be able to maintain its shape over time. The tripod structure of the nose will have to be reinforced with the use of sutures to create a new tip structure. Columellar strut grafts may be necessary to support the tip further.

The significance of the septum is often overlooked because it is not a visible structure. The septum is the key support structure that holds up the nose and also provides the foundation on which the tip is created. In patients with a poorly form septum, septal extension grafts are needed to create a strong base on which the new septum can be built. Ignoring this will create a tip that droops over time or loses height.

The fleshy nasal tip adds to the weight of a droopy and poorly defined tip. Reduction of the fleshy tip will allow the underlying cartilage to create a defined nasal tip. Together with reduction of the fleshy side walls of the nose, the alar can be made narrow to complete the look to create a refined and more petite nose.