What Works Best for Treating a Bulbous Tip in a Thick Skinned Patient?

Removing tip cartilage and suturing the remaining tip cartilage or adding tip grafts?

Doctor Answers 13

Treating a bulbous tip

This is a tough problem in rhinoplasty since the thick skin covers all of the fine tip work performed on the cartilages.  It is similar to the appearance of your foot when covered by a sheet versus a sheet and heavy blanket.  The toes just disappear.  I cannot think of an instance I would “remove” tip cartilage since this would reduce the support for the tip.  Adding tip grafts can be helpful since the change needs to be “overdone” to see the results.  Sometimes simply defatting or thinning the skin carefully can improve the appearance but there is always a risk of skin necrosis when this is attempted.

Each nose needs to be individually evaluated to see what narrowing technique works best

The things that we evaluate to determine how to narrow the tip of the nose is cartilage shape, size and strength along with skin thickness and desired result. For moderately thick skin and decent cartilage strength, carilage narrowing and sutures may be enough. For very thick skin strut and tip grafts may be necessary. This is best determined at the time of a personal evaluation when your surgeon can both look at and feel your nose. Tip grafts in other than thick skin may eventually show through, so they can be great but also cause problems if you aren't the right candidate.

Steven J. Pearlman, MD
New York Facial Plastic Surgeon
5.0 out of 5 stars 62 reviews

Tip rhinoplasty techniques

Tip rhinoplasty techniques really vary depending on the individual patient and their anatomy.  Both tip sutures and grafts can be options.  I would start with a few consultations in your area to address your concerns and see what solutions are suggested 

Rhinoplasty for Bulbous Tip

The technique itself in rhinoplasty is secondary to the execution of the technique.  Great and long-lasting results can be obtained in the right hands with either method.  Given this however, if tip cartilage is removed, it is important that only the appropriate amount of tip cartilage is removed in order to avoid long term complications.  It is helpful if your tip requires increased projection as projecting into thick skin helps to increase tip definition.

Anthony Bared, MD
Miami Facial Plastic Surgeon
5.0 out of 5 stars 35 reviews

Bulbous tip treatment

First, an exam is essential to determine what would be best for you. Sometimes defatting of the tip is necessary. Grafts that you had may help and tip suturing as well.

Steven Wallach, MD
New York Plastic Surgeon
4.0 out of 5 stars 22 reviews

Treating a bulbous tip with thick nasal skin

If you have thick skin combined with a bulbous nose, a combination of techniques will give you the best result. Most patients that I treat with this problem will require:

-Cephalic trim to narrow the height of the cartilage

-Tip suturing techniques to narrow and define the tip cartilages

-Tip grafts to increase definition and contour

-Thinning of some of the fatty tissue and muscle under the skin

Jamil Asaria, MD
Toronto Facial Plastic Surgeon
5.0 out of 5 stars 80 reviews

Bulbous Tip with thick skin

The Bulbuos tip responds will to reshaping of the tip cartilage, which often involves trimming of a portion of the tip cartilage and reshaping the remainder with stitches to gain a more desirable shape.  When the skin is thick, cartilage support becomes more important to provide definition.  Therefore, in some patients, cartilage grafting may be used. RB

Ramin Behmand, MD
San Francisco Plastic Surgeon
5.0 out of 5 stars 23 reviews

Best Treatment for Bulbous Nasal Tip in Thick Skinned Patient

Hi Big A Nose,

Best treatment for bulbous tip in thick skinned patient is reduction of cartilage, leaving enough cartilage for support, and then using tip grafts for shape.  Good luck and be well.

Dr. P

Michael A. Persky, MD
Encino Facial Plastic Surgeon
5.0 out of 5 stars 29 reviews

Bulbous Tip


The best way to treat a thick skinned bulbous tip is to remove the fat from under the tip and add cartilage grafts to re-support the tip. There are many examples to this on the website link below and the video.



Oleh Slupchynskyj, MD, FACS
New York Facial Plastic Surgeon
5.0 out of 5 stars 240 reviews

Treating a bulbous tip and thick skin

There are usually a few things that are needed to improve a bulbous tip in combination with thick nasal skin. Cartilage grafting to adequately build up and support the nose is important in many cases. It may also be possible to thin the skin a bit if there is an excessive fibro-fatty tissue pad under the skin.

Steroid injections may be recommended after surgery to help with the healing process as well.

You can check out my blog post link below to learn more about bulbous tip treatment.

Thomas A. Lamperti, MD
Seattle Facial Plastic Surgeon
5.0 out of 5 stars 17 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.