As a result of a aging nose, I'm confronted with tip bulbosity. By resecting some cartilage or dome suturing this can be narrowed. However lower lateral cartilage instability (and apparently lack of support) in the tip will still occur. Which grafts could you use to correct this?
Tip Bulbosity in Aging Nose
Doctor Answers (5)
Key Elements of Managing the Aging Nose
The 5 key elements of managing an aging nose are the following 1.) Less is more. 2.) Minimal changes for maximum results. 3.) Refinement without tip grafts 4.) Correction of associated drooping nasal tip with the bulbous tip 5.) Making sure that the nasal correction in an aging patient is in harmony with the patient's face. Often I do the correction of an aging nose with a facelift so that this is in harmony with the face and nose.
Bulbosity of aging nasal tip
The bulbosity of the tip is indeed reduced by removal of tip cartilage and suturing techniques. If the lower lateral cartilages had been stabilized at the time tip suturing techniques were performed, they usually do not need any further cartilage grafts, which could widen the nose if placed.
Bulbous nasal tip in aging nose.
Preserving a 5mm or more rim of cartilage in the lateral alar crura will preserve nostril rim support and prevent nostril collapse with inspiration. Weakening (by scoring or dividing the cartilage) and suturing the nasal domes to improve projection, refinement, and reduce tip width actually provide additional tip support also, particularly when the surrounding scar tissue is carefully held in place with tapes and/or splints.
Sometimes additional definition is needed, and shield or layered tip cartilage grafts are utilized; the tip can be further supported in certain types of nasal anatomy with cartilage struts sutured between the medial crura of the alar cartilages to preserve tip projection.
Aging can also be associated (in some patients) with acne rosacea worsening and causing sebaceous hyperplasia and skin thickening (rhinophyma). Laser treatment for the skin thickening can significantly reduce the bulbous appearance of rhinophyma.
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Bulbosity of aging nose.
The aging nose can become more bulbous looking due to changes that occur in the attachments of the cartilages . Also skin changes can cause a bulbous look as in the condition known as rhinophyma. What will help your nose appear better cannot be determined without an examination. Possibly some on-line comments could be made if you submitted a series of pictures.
As long as you leave a 5mm lower rim strip of cartilage left behind that is not true. In the vast majority of patients that 5mm provides enough support to give you structural integrity. For extra safety I test all patients before surgery by closing off a nostril, have them breathe through the other nostril and then test the opposite side. If I detect weaker than normal tip supporting cartilage I will then leave a 7 or 8 mm wide strip. If the patient has had previous surgery with too much cartilage removed or inherently weak cartilage resulting in collapse cartilage alar spreader or lateral crural batton grafts may be required.