A simple open approach to suture the tip cartilages together can refine the tip. Adding a tip cartilage can provide further tip projection. To narrow the tip width, alar resections can be performed. Best wishes!
The bulbous tip is addressed with suture techniques to the lower lateral cartilages to narrow and refine them. Medial and lateral osteotomies of the nasal bones are required to narrow the bridge line. An alar platy is required to narrow wide nostrils, but is performed at rest, not upon animation. The nose will still widen with smiling due to the facial musculature.
The tip can be refined through a closed approach without any visible scars. The nostril width can be decreased as well.
Kenneth Hughes, MD
Los Angeles, CA
Efitz1: Thanks for your question. I agree your profile is nice. It is difficult to significantly change the appearance of your nose when you have thick, oily skin. You can thin the skin somewhat and then refine the tip cartilages and add a columellar strtut and something called a shield graft to further stretch the skin out. However, these maneuvers would move the tip of your nose further from your face, so you might need additional grafting to the dorsum to keep your nose in balance; this would make your bridge look narrower also, which you would probably like. Given the prior septoplasty, you probably don't have much usable cartilage from your septum so you might require ear cartilage harvest, which isn't a huge deal.
It looks like you live just down the road from me, and I would be happy to meet you for a full consultation. Best of luck.
It is difficult, if not impossible, to substantially thin out the nasal skin from the outside particularly on the tip of the nose. The most 'conservative' way to thin out your nasal tip would be a closed rhinoplasty with tip defatting and cartilage narrowing with nostril narrowing done from the inside of the nostrils.
You ask for a conservative approach to treating your bulbous tip. Aggressive treatment by an experienced skin professional (aesthetician or Dermatologist) may reduce the thickness of the thick oily envelope of skin. I frequently have our aestheticians treat patients like you even if they plan on rhinoplasty surgery.