What to Do with This Bulbous Nose? (photo)

Hello,

It is possible to make the tip smaller and more defined during an open rhinoplasty surgery. However, patients with thick skin may not always achieve the level of definition they desire. In addition, swelling may linger for a longer period of time with patients that have thick skin. The final result of surgery will not be evident for up to 24 months following surgery.  The width of the nose can be reduced with osteotomies. Thank you, and I hope this helps answer your questions.

Dr. Nassif

Based on your photos it appears that you have prominent and convex alar cartilages which can be reshaped and sculpted with rhinoplasty.  You also have thick skin which needs to be taken into consideration

It is impossible to fully answer your questions solely on the basis of your limited posted photos. The area you outlined is called the ala. The dome of the tip in the third photo is broad and that can be narrowed by suturing the 2 C-shaped tip cartilages together. If the nostril rims are more than 3 or 4mm in width they can be narrowed by removing fat from within the rim. The nasal width is assessed by comparing it to other facial structures but those are not included in your posted photos.


I hope you realize that this format of posting questions and receiving answers lacks the face to face direct communication required for you to make an informed decision regarding your surgery.

My response to your question/post does not represent formal medical advice or constitute a doctor patient relationship. You need to consult with i.e. personally see a board certified plastic surgeon in order to receive a formal evaluation and develop a doctor patient relationship.

Excessive width of the nose and a bulbous nasal tip can be refined with #rhinoplasty. Seek an expert. Rhinoplasty is commonly performed but is the most challenging cosmetic procedure. Because of this, you want to find a rhinoplasty expert who has the best chance of giving you a pleasing result while maintaining your breathing the first time around. Seek a Facial Plastic Surgeon or Plastic Surgeon with board certification and alot of rhinoplasty skill. Look at photos of their patients' results. Ask them to "morph" your pre-operative images to ensure that you are both on the same page. This is not a guarantee of results but is a communication tool that ensures that you are both seeking to achieve the same result. Thank you for your question. Stephen Weber MD, FACS

Cartilage width and skin thickness typically add to a wide or bulbous nose.

A tip plasty including suture refinement as well as cartilage reduction in the area above the tip defining point will result in reduction of volume. This is a fairly standard operation for any surgeon that does a lot of nasal work. If your skin is too thick or the cartilages are soft, then cartilage grafting may be required to add structure and definition to the tip.

The volume in the nostrils can be slightly reduced. However, there is no specific structure that can be shaved or modified in that area. Some thinning of the fibrofatty soft tissue can be done. However, predictions about result are difficult in that region of the nose.

Best of luck

Rhinoplasty for the wide nose with a bulbous tip and hump is a common procedure. You should be cautious about the surgeon you choose to make sure he has the same aesthetic taste that you do and is very experienced.

In your case, the bulbous tip is the product of cartilage that is too broad and overly supportive of the overlying skin.  Because the outline of the lateral arm of the cartilage is very distinct, it means the skin is thin and is not obscuring the detail generated by the shape and projection of the cartilage.  Trimming and manipulation of the shape of the remaining cartilage should allow you to get a good result.

The photographs are helpful, although I would like to see more views.  The ala, or outer (lateral) walls of the nostrils -- if thick -- are the least likely to be improved.  People think that just because the walls are thick, that narrowing the floor of the nostrils or the nostril sills would be helpful, but it won’t.  Only when the floors themselves are very wide is nostril narrowing indicated.  It is an excellent procedure for certain noses, but I suspect that in your case that may not be totally appropriate. 

Regarding the bulbous tip and its lack of definition: there are very sophisticated techniques which would be helpful.  It is not that unusual an anatomic finding, and techniques for improvement include adding on cartilage at the time of surgery.  Such a “tip graft” can be very helpful.  You may also be a candidate, at some point after the basic surgery is done, to have further augmentation, if indicated, using permanent injections. 

You would need to do a lot of homework and study up as much as you can.  Visit a lot of websites, read books, and then consult with the doctors that seem to have the most experience in this type of surgery.  Without being able to see all the views, feel the tissue and examine the nasal interior, I am a bit limited in giving further advice, but you are on the right course.  You have gotten off to a good start here on RealSelf.

Robert Kotler, MD, FACS
Nasal and Facial Plastic Surgeon
Author, SECRETS OF A BEVERLY HILLS COSMETIC SURGEON

The bulbous portion of the tip will require a combination of cartilage removal and suturing techniques to create a more pyramidal, pointed, and angular tip.  Osteotomies will narrow the width of the bridge along with a slight hump removal.  The entire nose can be made much smaller and refined.

Your tip can be improved quite a bit with rhinoplasty. Tip shaping sutures, careful cartilage removal and depending on your skin thickness structural grafts to flatten the lateral crura will give you a smaller more defined and balanced tip.