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Correcting Nose to Lip Angle and Bulbous Tip

How to correct acute nose to lip angle and bulbous tip at same time? My nose and lip angle is approximately 70 degrees and I have a bulbous tip with a large base. I am an Indian so I have thick skin, I guess.

What would be the best possible way of correcting all the 3 faults together, while keeping in mind the skin thickness? Can nose to lip angle change only by trimming the septum or is there any other way to do so?

Doctor Answers (15)

Ways to correct nose to lip angle and bulbous tip

+2

The bulbous tip can be addressed through a full delivery technique. Suturing of the dome to the lower lateral cartilages can be performed with the possible addition of a cartilaginous strut graft if needed for support. Any large, wide nostrils can be address through Weir alar-based excisions if needed. Thick, olive, oily skin will need Kenalog shots in the supratip area starting at the time of surgery and during the first, second, and third month following surgery. Any type of acute angle to the lip can be addressed by raising the tip, by trimming the caudal membranous and cartilaginous septum.


Seattle Facial Plastic Surgeon
5.0 out of 5 stars 58 reviews

Correcting Nasolabial Angle and Bulbous Tip

+2

Rather than self-diagnosis, and then studying all the various techniques and combinations of techniques, see a rhinoplasty surgeon who will examine your nose and make suggestions based on his/her experience. After the evaluation ask that physician about alternatives, with the advantages and disadvantages of each. You may want to get more than one consultation. Then you can make an educated decision.

Richard W. Fleming, MD
Beverly Hills Facial Plastic Surgeon
5.0 out of 5 stars 15 reviews

Correcting an ethnic or Indian nose

+2

The nose issue that you are describing is very common in Indian noses. Specificially, thick skin with a large bulbous tip with a wide base and a ptotic tip with a poor columellar labial angle. The ideal columellar labial angle for a female is about 105 to 115 degrees and about 95 degrees for a male.

Ways to correct that include taking down some anterior septal angle to allow upward tip rotation as well as techniques that alter the tip itself or tripod of the nose and lengthen the medial crus or columella so that it projects upward and rotates.

Other methods include shortening the lateral or gull wing aspects of the tip cartilages. These maneuvers can be combined to narrow the tip and improve the columellar labial angle at the same time. Finally, the alar base reduction can be done at the same time as a Rhinoplasty and well narrow the base so tat it is not as wide. I hope this information helps.

Scott Trimas, MD
Jacksonville Facial Plastic Surgeon
5.0 out of 5 stars 9 reviews

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Correcting nasolabial angle and bulbous tip

+1

It is difficult to say without pictures, but with my experience in ethnic noses with thick skin a different approach is indicated.  The bulbous tip is corrected by performing a cephalic trim of your lower lateral cartilage and suture techniques, but a satisfactory result in an ethnic nose also usually requires a hearty columellar strut to support the tip, change the nasolabial angle and provide appropriate columellar show.  I hope this helps!

 

 

All the best!

 

Rian A. Maercks M.D.

Rian A. Maercks, MD
Miami Plastic Surgeon
5.0 out of 5 stars 32 reviews

Rhinoplasty

+1

The nose and lip angle can be addressed in several ways. One as you said is by working with the septum. You may also benefit from a columella strut and tip sutures alone or to the septum to raise the tip.

Steven Wallach, MD
Manhattan Plastic Surgeon
4.5 out of 5 stars 17 reviews

Correcting nose to lip angle and bulbous tip

+1

Shortening the caudal end of the septum and rotating the nasal tip will increase the nose to lip angle. Subcutaneous fillers (I prefer septal or ear cartilage) will create a fuller, less acute angle.

A bulbous nasal tip requires definition. Careful judicious sculpting of the tip (lower lateral) cartilages perhaps with a modification of a Goldman type tip (vertical dome division) procedure and possibly with a supporting columella strut and/or batten grafts have been helpful in my experience.

Sigmund L. Sattenspiel, MD
Freehold Facial Plastic Surgeon

Improving the nose-lip angle with rhinoplasty.

+1

Many options exist for addressing the angle between the lip and the columella of the nose. Caudal extension grafts designed to project the nasolabial angle can work well as can plumping grafts. Creating proper tip rotation is a typical aspect of rhinoplasty and is often combined with creating better tip definition. The definition, however, is limited, as you suggested, by thicker skin.

Trimming the septum at the anterior angle *may* also be employed, but a specific recommendation on that would require an actual exam of your nose.

All the best,

--DCP

David C. Pearson, MD
Jacksonville Facial Plastic Surgeon
5.0 out of 5 stars 14 reviews

Nasal Tipplasty

+1

Hi Neyhaa,

Bulbous tip, acute columella (nose) lip angle and wide nares can all be corrected by doing a tipplasty, assuming tat the rest of the nose is satisfactory. Sculpting the tip by cartilage removal, repositioning and permanent sutures as well as placement of columella cartilage grafts can alter and improve the ange and shape of the tip. Thick skin creates its own challanges but can be compensated for in the experienced hands. External incisions would be needed at the base of the nares to narrow a wide nose. These will heal inperceptibly over time. Good luck.

Andrew Pichler, MD
Sacramento Facial Plastic Surgeon
5.0 out of 5 stars 3 reviews

Combination of nasal grafts and increase of nasolabial angle would likely help

+1
You have provided a very nice summary of the issues that you have with your nose. There are many ways to address the issues you currently have. Most surgeons would be very cautious in consideration of shortening the septal cartilage. Given the description of your nose, you would likely benefit from a combination of cartilagenous grafts to add tip support and definition, as well as increasing the nasolabial angle. An experienced rhinoplasty surgeon should be able to give you a good idea of the steps involved in addressing your nose.

Philip S. Schoenfeld, MD
Chevy Chase Facial Plastic Surgeon
4.5 out of 5 stars 6 reviews

Fixing a bulbous nasal tip

+1

Hi Neyhaa - A rhinoplasty can address the issues that you brought up of a bulbous nasal tip and acute nasal tip angle. The cartilages of the nose are trimmed to decrease the bulbous look to your tip and they can then be tailored to bring up the tip and increase the angle. The entire procedure is can be done as an outpatient with minimal post-operative discomfort. Good luck!

Jeffrey E. Schreiber, MD
Baltimore Plastic Surgeon
5.0 out of 5 stars 71 reviews

These answers are for educational purposes and should not be relied upon as a substitute for medical advice you may receive from your physician. If you have a medical emergency, please call 911. These answers do not constitute or initiate a patient/doctor relationship.