What to Do with This Bulbous Nose? (photo)

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.

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