I am wanting to have a Rhinoplasty to reduce my bulbous tip and to de-rotate my naturally upturned nose. How exactly does the surgeon fix my nose?
How Are Bulbous Tip and Upturned Nose Corrected?
Doctor Answers (15)
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De-rotation of your nose may not be easily obtained with Rhinoplasty surgery.
Most of the Rhinoplasty tip-modification techniques will lead to further rotation of your nose, or no rotation at all. You have an attractive appearance, and your nose-lip angle is appropriate.
Your nose does not appear too upturned on the profile photo provided. It's not impossible to derotate a tip, but in my hands, it's difficult, and unpredictable.
I'd like to try to talk you out of rhinoplasty, but I don't want to dismiss the whole idea without seeing your front view. Feel free to post / email your photo, and I'll be happy to give you my thoughts.
I've attached a link to my Rhinoplasty photos for your perusal.
I hope you find this helpful, and best regards.
Procedures for bulbous and upturned nose
The bulbosity of the nasal tip can be refined through dome suturing techniques whereby each lower lateral cartilages are sutured together with a dissolvable stitch that takes approximately four to six months to dissolve. The procedure, when done as an endonasal approach, will automatically decrease the upturned nose and will drop the tip as well as de-project the nose. A small supra-tip cartilage graft can also be placed to push the tip down.
Web reference: http://www.seattlefacial.com
Bulbous nose and upturned tip
You should seek a consultation with an experienced board certified plastic or facial plastic surgeon who does rhinoplasties frequently. The surgeon should first allow you to express what it is about your nose that you dislike and what yo would like to see improved. He/she will should then take a complete medical history and then examine your nose internally and externally and then make suggestions to you how to accomplish your goals and if they are realistic. It appears from your picture that you have a "boxy" nose from prominent lower lateral cartilages. Your surgeon will determine how to reduce the bulbous tip by modifying the cartilages (removing some and possibly grafting a little bit); he will decide whether you will need any bony work done since the proportions of the upper and lower nose will change and he may need to "in fracture" the bones to keep it from looking too wide. The surgeon will discuss with you the open vs the closed approach and which he recommends in your case and why. Do not be afraid to ask questions about the number of procedures the physician has done, see pictures and possibly talk with other patients who have had similar problems treated. Ask about the potential risks and complications, how often they occur, can the surgeon address them if they happen, and certainly what additional costs might be incurred if problems do arise. A board certified surgeon does not guarnatee you will avoid problems or complications but it does significantly decrease the risk and the surgeon can addres any problems that might arise.
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A nose bulbous tip is corrected by removing some cartilage and either suturing together or weakening the remaining cartilage
Because these two problems are quite distinct, I will try to answer them for you separately. Although I am often happy to perform rhinoplasty surgery through a “closed” or endonasal technique, the two problems that you are concerned about generally are easier to address using an “opened” technique so that the cartilage can be directly and clearly visualized.
A bulbous tip is the more easily corrected of the two problems. This is done by removing some cartilage and either suturing together or weakening the remaining cartilage. The most critical element to correcting a bulbous tip, however, is to not overcorrect the tip. In other words, it is important to not create a single narrow tip; instead, two distinct “tip defining points” should be left intact so that the nose looks as natural as possible. In addition to narrowing the cartilage, there is often excessive soft tissue between the skin and the cartilage. If this can be sculpted and or removed, the tip will appear even less bulbous.
There are two ways to approach correction of a nose that is naturally upturned: the first, to increase the apparent length of the dorsum of the nose, thereby making the tip less unturned; the second, to shorten the base of the nose by shortening the septal cartilage or removing soft tissue at the base of the nose, thereby eliminating the upturned appearance without actually lengthening the nose. The decision about which approach to take would involve a very detailed analysis and individualized plan to address your concerns.
Lengthening the Nose
Stacey: I will play devil's advocate and question if your nose is really too short (over-rotated). The columella (the strip between your nostrils) appears to be hanging, which could give the illusion of too much rotation. However, if de-rotation is necessary, it is best done by someone with experience because this is one of the more difficult maneuvers in rhinoplasty surgery.
Repostioning tip cartilages "lower" can work
Taking care of a bulbous tip is easier than relocation the nasal tip lower. As rhinoplasty specialists we all have lots of experience in scultping the tip but lowering the tip remains a challenge. One technique I have used is to release all the attachments of the tip cartilages and bring the tip lower. This can usually accomplish a slight lowering of the slightly elevated nasal labial angle you have.
Bulbous tip and upturned nose correction
Modern rhinoplasty is customized to each nose with a specific repertoire of surgical techniques.
To refine a nasal tip and then reposition it in a less prominent position the following surgical sequence is usually done.
First the nasal tip is refined by thinning the widths of the lower lateral cartilages. Then, these cartilages are united and shaped with several stitches until a small, more defined tip is created. When the nasal tip has been created, IF there is no further work to be done on the nose such as septal work, inferior turbinate work, reduction or augmentation of the dorsum of the nose or in fracturing of the sides of the nose, then the tip is repositioned in its new location in relation to the dorsum.
There are multiple ways to reposition the nasal tip, which vary according to what we try to accomplish. If all we try and do is LOWER the tip in a vertical direction (not move it forward to lengthen the nose or move it in to shorten the nose), this can be done either through access from the front (ceiling) or the side (transfixion), going in between the lower lateral cartilages and the front end (caudal edge) of the septum. The suspending attachments of the tip are divided or weakened. In trial fashion, a small caliber needle is then used to hold the tip at the level we think it belongs and we re-drape the skin and check. This is done several times until the perfect nasal tip placement is found. A suture is then placed between the vertical extensions of the lower lateral cartilages of the tip and the edge of the septum, securing that position and the needle is removed. The incisions are then closed.
I hope this boring technical description is what you were looking for and that this was helpful.
Rhinoplasty and upturned nose
As a general rule a bulbous tip can usually be treated by performing tip surgery to refine the lower lateral cartilages. This can be done with some excision of the cartilages and tip sutures. If the bulbous component is due to the thick skin, then it is very difficult to improve it. If the tip is "too upturned," then sometimes grafts can be placed internally to de-rotate the tip a bit.
On the one view that you posted, your nose looks great, and I recommend leaving it strictly alone. It is easy to make a nose such as yours worse with surgery.
If your tip really is bulbous (in front view), then that can be reliably corrected.
How are bulbous tip and upturned nose corrected?
Thanks for including your picture.
Usually, the cartilage at the tip of your nose is re-shaped to the desired width and location. I prefer to do this through an incision at the columella that extends into the nose. In rare cases, if the person had previous nasal procedures, implants may be required to obtain the desired shape. Computer modified pictures of your current nose can help with the communication process between you and your doctor.
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.
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