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How Do You Fix a Nose with a Bulbous Tip?

How exactly is excess tissue removed from the tip of the nose?

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bulbous

How is a bulbous nasal tip fixed during Rhinoplasty?

I have performed Rhinoplasty for over 20 years and what's required to thin a wide (bulbous tip) depends on several factors including the angle of tip rotation, if the tip cartilage is asymmetric or weak and whether the skin is thin or thick. Taking all of these factors into account along with the proper nasal aesthetics (differ for men and women) an individualised plan for the Rhinoplasty can be formed. The tip cartilages will be typically trimmed and possibly sewn... more

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Francis R. Palmer, III, MD

Beverly Hills Facial Plastic Surgeon

Nasal bulbous tip

The most precise way to correct a bulbous nasal tip is to perform an open rhinoplasty. The tip can be bulbous for several reasons. Some of these include, thick soft tissues, wide nasal cartilages, and flat tip to name a few. A careful physical exam will provide the answers and then a surgical plan can be created.

Steven Wallach, MD

Manhattan Plastic Surgeon

ASAPS ASPS

Closed rhinoplasty and refining a bulbous tip

I have a different take then others that have posted. I see very few indications to ever performing an 'open rhinoplasty.' While the difference between an open rhinoplasty and closed rhinoplasty is only a few millimeters of tissue that is preserved or cut, it is very important tissue. Inside the columella there are important arteries and veins and preservation of these vessels makes maneuvers like debulking the tip much safer and sppeds healing recovery and... more

Rian Maercks, MD

Miami Plastic Surgeon

Rhinoplasty for Bublous Tip

Absolutely, a good rhinoplasty by an experienced rhinoplasty surgeon can refine a bulbous tip nicely. The limiting factor is skin thickness, the thicker the skin the harder it is to gets definition.

Richard Galitz, MD

Miami Facial Plastic Surgeon

How Do You Fix a Nose with a Bulbous Tip?

Thick skin and large cartilages are the reason for bulbous tip. The cartilages are reduced and sutured to refine the structure but most importantly the skin needs to be aggressively thinned to achieve adequate drapping over the refined cartilagenous structure.

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Mohsen Tavoussi, MD, DO

Huntington Beach Facial Plastic Surgeon

Usually a combination of things is done

A bulbous tip which is caused by enlarged cartilage is best improved by a combination of removing some cartilage and using suture techniques to create a better shape. Sometimes a nasal tip looks wide because it lacks projection and placing a cartilage graft can both improve the projection and create a tip that looks more narrow. Sometimes the tip skin is thick, and this can be carefully thinned down to help the overall shape. The bottom line is that many things can be done to improve... more

Andrew Miller, MD

Edison Facial Plastic Surgeon

Correcting a Bulbous Tip

The appearance of a "bulbous tip" most commonly arises from the shape of the underlying cartilages. If this is the case, the lower lateral cartilages (tip cartilages) can be trimmed and reshaped either with sutures or with grafts to relieve the excess curvature. Sometimes, increasing the amount of tip projection makes the nostril sidewalls straighter and can help alleviate bulbousness Thick skin is an additional factor that can contribute to a bulbous tip. Thinning the... more

C. Spencer Cochran, MD

Dallas Facial Plastic Surgeon

Usually, nose tissue is not removed but reshaped

Removing tissue from the tip of the nose for a bulbous tip is actually a risky maneuver. This can devascularize the tip and lead to skin death at the tip of the nose. Most of the time, cartilage reshaping can do wonders to narrow the tip even in the Asian nose. Many believe in the surgical community, that the nasal tip of the ethnic nose is mostly fat and thick skin. This is true to an extent but with proper shaping of the cartilage siginificant changes can be made to the tip and the... more

Philip Young, MD

Bellevue Facial Plastic Surgeon

Typically fixed by removing excess cartilage

A bulbous tip can be caused from excess cartilaginous tissue and widely shaped and divergent cartilages in the tip of the nose. This type of a tip is usually fixed by removing a portion of the cartilage and sewing the cartilages together with semipermanent sutures to narrow and refine the tip.

William Portuese, MD

Seattle Facial Plastic Surgeon

It depends on what is going on

A bulbous tip can be caused by a combination of things: too much tip cartilage, tip cartilage that is in the wrong position, and tip cartilage that is too splayed apart. A careful analysis by an experienced rhinoplasty surgeon can help determine which problems a patient might be experiencing. The correction then is determined by the cause. A bulbous tip can be improved through both an open and closed rhinoplasty approach. Additionally, excess tissue at the tip may be due to extra fat in the... more

Manish H. Shah, MD

Denver Plastic Surgeon

ASAPS ASPS

Few different ways to reduce bulbous nasal tips

The procedures used to reduce tissues in a bulbous tip can vary. This depends mostly on the exact nature of the bulbous tip. First, the surgeon must correctly diagnose what makes the tip have the appearance of excess. Occasionally this is excessive skin in the lower third of the nose. Sometimes it is a true excess of cartilage in the upper portion of the lower lateral or tip cartilages, and other times the problem is poorly shaped, or weak tip cartilages. There are also cases in which the... more

Behrooz Torkian, MD

Beverly Hills Facial Plastic Surgeon

How is a bulbous tip reduced?

This is a great but difficult question to ask. Generally when approaching the bulbous tip the vast majority of cases are treated by reducing the cartilage structures that give the tip support and definition. This can be performed by literally cutting the cartilages or by shaping them with stitches or other pieces of cartilage. However the tip is not just made of cartilage, it is also covered by layers of fat, muscle and skin, You must look at this as a physical structure that is... more

Otto Joseph Placik, MD

Chicago Plastic Surgeon

ASAPS ASPS

Rhinoplasty...The Bulbous Nasal Tip

Hi RB, The problem that is causing the bulbous tip needs to be diagnosed so that the proper surgical treatment can be carried out to correct it. Usually a bulbous tip is due to excess lower lateral cartilage or misshaped cartilages. It is usually corrected by delivering the lower lateral nasal cartilages (that make up the lower 1/3 of the nose), and removing the excess. Sutures are frequently used to either reshape the cartilages, or to narrow the distance between them. Occaisionally... more

Michael A. Persky, MD

Los Angeles Facial Plastic Surgeon

Tip shape is an important part of rhinoplasty

Tip shape is a very important part of the rhinoplasty procedure. The concept of just how the tip is shaped and improved during the procedure can be hard to understand, and the American Society of Plastic Surgeons has a video on their site that helps describe the process. In rhinoplasty the skin of the nose is not altered, only the support underneath which defines the shape. The supporting cartilages and bone are modified so that the skin will form itself around these changes and establish... more

Peter E. Johnson, MD

Des Plaines Plastic Surgeon

ASAPS ASPS

Tip Narrowing and Refinement Can be Done in Ways that Provide a Natural Long Term Look

The main concern for many people seeking Rhinoplasty is a wide, boxy, or bulbous nasal tip. They’d like it to be narrowed and more refined but are afraid of having a pinched or unnatural look. Excessive pinching from tip narrowing is really a preventable complication that happens from overaggressive cartilage removal or inappropriate suture techniques. For many years, the standard technique for tip narrowing was thinning of the upper edge of the tip cartilages, what we call a cephalic... more

Peyman Solieman, MD

Beverly Hills Facial Plastic Surgeon

Fixing bulbous nose tip depends on anatomy

A bulbous tip usually comes from the shape of the underlying tip cartilage. This cartilage may sometimes be reshaped. The overlying skin then adapts to the new supporting structure underneath. It is important to realize the limits in treating the bulbous tip. The most important thing to remember is that these very cartilages are doing a big job, holding a portion of the nasal airway open. So, the aesthetic wishes must be balanced with the functional need. Those patients with thick skin may... more

Phillip Langsdon, MD

Germantown Facial Plastic Surgeon

Fixing the bulbous tip

A bulbous nasal tip has much more to do with how the tip relates to the rest of the nose than just removing and shaping cartilage. I often see patients who still complain of having a bulbous tip after a rhinoplasty by another surgeon and the tip has had too much cartilage removed. A bulbous tip may be that way because the tip cartilage is too broad or separated too much, but it often it is not. A tip looks bulbous when the light that hits the tip forms a shadow at the lateral aspect of... more

Edward Buckingham, MD

Austin Facial Plastic Surgeon

The bulbous tip usually represents an enlargement of the underlying cartilages

The bulbous tip usually represents an enlargement of the underlying cartilages. When reshaping a nose, it is important to evaluate the entire nose to produce a well balanced outcome. As the cartilages are trimmed and reshaped, the overlying skin redrapes and conforms to the new shape. Think of a nose as a tent: the skin is the canvas of the tent, and the cartilages are the poles and structure. As the poles are trimmed, shortened, or moved, the canvas adjusts to the new structure. more

Ricardo Izquierdo, MD

Chicago Plastic Surgeon

ASAPS ASPS

It depends on exactly what the problem is.

Usually the cause is too much cartilage in the tip or the wrong shape of the cartilage. It can be too thick skin and tissue above the cartilage. Best to se an experienced rhinoplasty surgeon for an evaluation.

Toby Mayer, MD

Beverly Hills Facial Plastic Surgeon

Bulbous tips are fixed by reshaping the underlying lower lateral cartilage

When considering the changes that would make a nose look better and function better, it is important to analyze the entire nose. It is important to bring the whole nose into harmony. While the bulbous nasal tip is most often changed by reshaping the lower lateral cartilages. These are made up of a medial crus which supports columella which is the part between the nostrils and the lateral crus which supports the dome of the tip of the nose. Often the top part is removed and the remainder is... more