Options For Addressing Bulbous Nose Tip, but Narrow Bridge, And Sinus Issues? (photo)

I'm interested in a rhinoplasty for functional & cosmetic reasons. I've had sinus issues for years, blockage, chronic light bleeding only on my right side. My nose doesn't look asymmetrical. My bridge is bony & high & is also very narrow in comparison to most people's noses that I see, which is why I have sinus problems? My nose tip is very, very bulbous, which I would like to correct as well. Is there hope that I can fix these 2 problems? I've heard bulbous noses are hard to correct. Thank you.

Doctor Answers 10

Nasal surgery for bulbous tip, narrow bridge and nasal blockage

You can certainly have nasal surgery to address all of your concerns. Rhinoplasty can improve your tip bulbosity to create a better balance between your tip and bridge. I suspect that bringing down how high your bridge is may actually help with the narrow appearance as well.

To determine the cause for your nasal blockage you would need an examination to assess your entire nasal airway. Septal deviation, turbinate overgrowth, polyps, or external/internal nasal valve collpase can contribute to chronic congestion. Find a surgeon comfortable with both functional and cosmetic nose surgery so that you can have one surgery to address both areas of concern at the same time.

Bulbous noses are very treatable using the proper techniques. Your bulbosity appears to be due, at least in part, from the convexity of your nasal tip cartilages in that area. These cartilages can be made more flat which will greatly improve the fullness there.

Seattle Facial Plastic Surgeon
4.9 out of 5 stars 21 reviews

Options For Addressing Bulbous Nose Tip, but Narrow Bridge, And Sinus Issues?

 From the photo, your nasal bridge width is aesthetically correct: the nasal tip is wide and a bit bulbous as you have mentioned.  Thre's no side view, so I can't tell for certain but suspect that the nasal bridge may also have a dorsal hump that should be reduced.

 I have performed Rhinoplasty for 20 nyears and IMO, the nasal hump can be removed (osteotiomies would be required to close the open space normally created when removing a dorsal hump) and the nasal tip thinned and refined.  I performed  many endoscopic sinus surgery procedures during surgical training and I suggest that you have that as a separate procedure as this frequently requires an out-fracturing of the middle turbinate that can cause synechea (mucosal band between turbinate and septal mucosa) because of the proximity between the turbinate and the Closed Rhinoplasty incisions.  These two surgeries should be spaced at about 6 months apart.

Francis R. Palmer, III, MD
Beverly Hills Facial Plastic Surgeon
4.6 out of 5 stars 24 reviews

Addressing bulbous nose tip with narrow bridge and sinus issues

Functional reasons for having nasal surgery include chronic sinusitis, which is treated by endoscopic sinus surgery.  Allergies and postnasal drip are always treated with medications such as cortisone nasal sprays and antihistamines.  Bleeding in the nose is treated with silver nitrate and cautery.  Blockage of the breathing passages can be due to a multitude of issues that includes a deviated septum, valve collapse, turbinate hypertrophy, and allergies.  An examination of the nose must be performed to determine what the cause is.  With respect to the cosmetic portion of the nose, the bulbous tip can be reduced with tip suturing techniques, sometimes tip cartilage is removed as well.  Both functional and cosmetic nasal surgeries can be performed at the same time.  Any functional medical issues are typically billed to the patient’s medical insurance out of medical necessity while cosmetic nasal surgery is billed directly to the patient.

William Portuese, MD
Seattle Facial Plastic Surgeon
4.8 out of 5 stars 143 reviews

Septorhinoplasty to Improve Appearance and Nasal Function

Sinus surgery and a rhinoplasty to improve nasal shape and function can all be done at the same time. Bulbous tips can be difficult, but you are fortunate because your tip skin does not appear terribly thick.

Richard W. Fleming, MD
Beverly Hills Facial Plastic Surgeon
4.9 out of 5 stars 38 reviews

Options For Addressing Bulbous Nose Tip, but Narrow Bridge, And Sinus Issues? (photo)

You can have surgical correction for all your issues in one operation. Best to be examined in person by boarded surgeons in your area. 

Darryl J. Blinski, MD
Miami Plastic Surgeon
4.6 out of 5 stars 173 reviews

Rhinoplasty and Endoscopic Sinus Surgery

First, you would need an in-person exam and appropriate work-up to ascertain what type of surgery is best.  Let's go on the assumption that your nose is not more complex than seen in the one photo.  Also, let's assume that proper imaging has been done and that appropriate medical management for the sinusitis has already been given.

Second, the rhinoplasty can be done and is well within the capability of a good board-certified Facial Plastic Surgeon.  The bridge can be lowered and made symmetrical either with treating the bridge alone or with making  internal side cuts in the bone (depends on your in-person exam).  There are several techniques to narrow a bulbous tip.  For a large bulbous tip and open approach is usually best.  You photo looks like a closed retrograde technique would work (less swelling).

I have extensive experience with simultaneous rhinoplasy and sinus surgery.  This can be done with balloons and stereotactic localization (our trademarked B.E.S.T. procedure) if needed.  I also have lectured on this subject at plastics meeting and have done extensive literature searches on it.  There is little reason not to combine both.

David Alessi, MD
Beverly Hills Facial Plastic Surgeon
4.7 out of 5 stars 16 reviews

Best treatment for nose and sinus issues

sinus problems can be complex and should be worked up and evaluated by an ENT doctor..Cat scan may be needed

the nose itself can be treated with an open rhinoplasty.. bulbous tips should be greatly improved with suture and cartilage shaping methods

Jed H. Horowitz, MD, FACS
Orange County Plastic Surgeon
5.0 out of 5 stars 109 reviews

Rhinoplasty and sinuses

Certainly, if you have sinuses issues, they can be treated at the same time as a rhinoplasty.  A bulbous tip can be challenging but can usually be refined.

Steven Wallach, MD
New York Plastic Surgeon
4.1 out of 5 stars 29 reviews

Rhinoplasty with ballon sinuplasty is an option

Rhinoplasty  with functional nasal surgery is definately an option.  You would likely benefit from "spreader grafts".  This would improve your breathing and also make you nose look less narrow in the middle.  I would suggest a sinus CT preop.  If you have signifcant sinus disease, this could be treated at the same time.  New sinus surgery techniques (ballon sinuplasty) are less invasive and easier recoveries.  I would highly recommend you see a Board Certified Facial Plastic and Reconstructive Surgeon, as they are the only surgeons who are experts in rhinoplasty and sinus surgery.  Warmest regards.

Dr. Pippin

Gregory Pippin, MD
Metairie Facial Plastic Surgeon
4.2 out of 5 stars 7 reviews

Sinus surgery and Rhinoplasty

Sinus surgery and rhinoplasty can be performed at the same time.  In fact, functional nasal surgery and cosmetic rhinoplasty are preferred to be done together.  The height of your nasal bridge probably has nothing to do with your sinus issues.  Best to obtain a CT scan of your sinuses to get more insight into your problem.  Bulbous tips are challenging, but I would not say difficult.

Philip J. Miller, MD, FACS
New York Facial Plastic Surgeon
4.7 out of 5 stars 80 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.