How exactly is excess tissue removed from the tip of the nose?
How Do You Fix a Nose with a Bulbous Tip?
Doctor Answers (23)
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.
Typically fixed by removing excess cartilage
Rhinoplasty for Bulbous Tip
A bulbous nasal tip can occur for a variety of reasons. The majority of cases are related to excess nasal cartilage, widely separated nasal cartilage and thickened nasal tip soft tissue.
The treatment of this condition depends on the underlying anatomic deformity. For this reason a careful evaluation of the nasal anatomy should be undertaken before proceeding with correction.
In some cases reshaping of the nasal tip may involve trimming the lower lateral cartilages. In other cases the nasal tip may be reshaped by sewing the nasal cartilages together to minimize the nasal tip width. Finally, in some cases thinning of the nasal soft tissue may be necessary.
It’s important to individualize treatment based on the patient’s unique anatomic findings and aesthetic goals. For this reason, consultation with a board certified plastic surgeon with rhinoplasty experience is essential.
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There are actually several types of bulbous tips. The is a cartilagenous bulbous tip which typically occurs in caucasion patients. This requires resculpting or reshaping the tip cartilages to a more aquiline or structured look. The second kind of bulbous tip is a fatty bulbous tip which is typically seen in ethnic patients ( African Americans, Hispanics and Asian). These noses require not only cartilage grafting to the tip but also defatting of the tip thereby thinning the subcutaneous skin. The third type of bulbous tip is a result of scar tissue build up from a previous rhinoplasty which requires removal of the scar tissue and possible cartilage grafts. See link for more explanation.
The Primary Problem With A Bulbous Tip Is Excess Cartilage With A Suboptimal Shape.
The primary cause of a bulbous tip is excess cartilage that creates a sub-optimal shape. The procedure involves careful cartilage removal and reshaping. It is important to leave a strong framework in order to prevent collapse. Some patients also have excess fatty tissue, which can be thinned out. However, overly aggressive soft-tissue thinning can impair blood supply, which can lead to severe complications.
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 resolution of swelling. Perhaps more important are the aesthetic ramifications. When dealing with a bulbous tip usually a combination of maneuvers is indicated. One must debulk the soft tissue, trim the lower lateral cartilage, remove interalar tissue, suture the lower lateral cartilages together to refine and define the tip +/- a complex arangement of cartilage grafts to restore aesthetic dimensions. To get a true idea of the result that a surgeons maneuvers are having, the columella and its natural tensions must be present. This is near impossible to do with a divided columella in open rhinoplasty so it is much harder to judge the result of the underlying structure. I recommend finding a surgeon comfortable operating in a closed technique.
All the best,
Rian A. Maercks M.D.
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 together. A cartilage graft can be added if additional tip support is required or the skin is very thick.
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.
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.
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 the nasal tip, but it varies from nose to nose. The important thing is that you select a surgeon skilled in rhinoplasty to properly evaluate your nose and tell you what can be done. Good luck.
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.