Ways to correct nose to lip angle and bulbous tip
The bulbous tip can be addressed through a full delivery technique. Suturing of the dome to the lower lateral cartilages can be performed with the possible addition of a cartilaginous strut graft if needed for support. Any large, wide nostrils can be address through Weir alar-based excisions if needed. Thick, olive, oily skin will need Kenalog shots in the supratip area starting at the time of surgery and during the first, second, and third month following surgery. Any type of acute angle to the lip can be addressed by raising the tip, by trimming the caudal membranous and cartilaginous septum.
Correcting Nasolabial Angle and Bulbous Tip
Rather than self-diagnosis, and then studying all the various techniques and combinations of techniques, see a rhinoplasty surgeon who will examine your nose and make suggestions based on his/her experience. After the evaluation ask that physician about alternatives, with the advantages and disadvantages of each. You may want to get more than one consultation. Then you can make an educated decision.
Correcting an ethnic or Indian nose
The nose issue that you are describing is very common in Indian noses. Specificially, thick skin with a large bulbous tip with a wide base and a ptotic tip with a poor columellar labial angle. The ideal columellar labial angle for a female is about 105 to 115 degrees and about 95 degrees for a male.
Ways to correct that include taking down some anterior septal angle to allow upward tip rotation as well as techniques that alter the tip itself or tripod of the nose and lengthen the medial crus or columella so that it projects upward and rotates.
Other methods include shortening the lateral or gull wing aspects of the tip cartilages. These maneuvers can be combined to narrow the tip and improve the columellar labial angle at the same time. Finally, the alar base reduction can be done at the same time as a Rhinoplasty and well narrow the base so tat it is not as wide. I hope this information helps.
Correcting nasolabial angle and bulbous tip
It is difficult to say without pictures, but with my experience in ethnic noses with thick skin a different approach is indicated. The bulbous tip is corrected by performing a cephalic trim of your lower lateral cartilage and suture techniques, but a satisfactory result in an ethnic nose also usually requires a hearty columellar strut to support the tip, change the nasolabial angle and provide appropriate columellar show. I hope this helps!
All the best!
Rian A. Maercks M.D.
The nose and lip angle can be addressed in several ways. One as you said is by working with the septum. You may also benefit from a columella strut and tip sutures alone or to the septum to raise the tip.
Correcting nose to lip angle and bulbous tip
Shortening the caudal end of the septum and rotating the nasal tip will increase the nose to lip angle. Subcutaneous fillers (I prefer septal or ear cartilage) will create a fuller, less acute angle.
A bulbous nasal tip requires definition. Careful judicious sculpting of the tip (lower lateral) cartilages perhaps with a modification of a Goldman type tip (vertical dome division) procedure and possibly with a supporting columella strut and/or batten grafts have been helpful in my experience.
Improving the nose-lip angle with rhinoplasty.
Many options exist for addressing the angle between the lip and the columella of the nose. Caudal extension grafts designed to project the nasolabial angle can work well as can plumping grafts. Creating proper tip rotation is a typical aspect of rhinoplasty and is often combined with creating better tip definition. The definition, however, is limited, as you suggested, by thicker skin.
Trimming the septum at the anterior angle *may* also be employed, but a specific recommendation on that would require an actual exam of your nose.
All the best,
Bulbous tip, acute columella (nose) lip angle and wide nares can all be corrected by doing a tipplasty, assuming tat the rest of the nose is satisfactory. Sculpting the tip by cartilage removal, repositioning and permanent sutures as well as placement of columella cartilage grafts can alter and improve the ange and shape of the tip. Thick skin creates its own challanges but can be compensated for in the experienced hands. External incisions would be needed at the base of the nares to narrow a wide nose. These will heal inperceptibly over time. Good luck.
Combination of nasal grafts and increase of nasolabial angle would likely help
You have provided a very nice summary of the issues that you have with your nose. There are many ways to address the issues you currently have. Most surgeons would be very cautious in consideration of shortening the septal cartilage. Given the description of your nose, you would likely benefit from a combination of cartilagenous grafts to add tip support and definition, as well as increasing the nasolabial angle. An experienced rhinoplasty surgeon should be able to give you a good idea of the steps involved in addressing your nose.
Fixing a bulbous nasal tip
Hi Neyhaa - A rhinoplasty can address the issues that you brought up of a bulbous nasal tip and acute nasal tip angle. The cartilages of the nose are trimmed to decrease the bulbous look to your tip and they can then be tailored to bring up the tip and increase the angle. The entire procedure is can be done as an outpatient with minimal post-operative discomfort. Good luck!