Is there any way for my bulbous tip to be rectified with closed rhinoplasty? Nothing drastic. Me, but better (Photo)

Doctor Answers 10


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Hello and thank you for your question. Based on your photograph, you may benefit from a tip refining rhinoplasty. Your surgeon can accomplish this by trimming, suturing, and reshaping the cartilage in your lower nose. Cartilage grafts may also be used to help improve tip refinement.  Make sure you specifically look at before and after pictures of real patients who have had this surgery performed by your surgeon and not just a computer animation system. The most important aspect is to find a surgeon you are comfortable with. I recommend that you seek consultation with a qualified board-certified plastic surgeon who can evaluate you in person.

Best wishes and good luck.

Richard G. Reish, M.D.
Harvard-trained plastic surgeon

New York Plastic Surgeon
5.0 out of 5 stars 174 reviews

Closed Rhinoplasty all the way!

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This is an ideal nose for scarless closed rhinoplasty! Depending on your needs your surgeon would perform delivery of the cartilages (no external cuts used), cephalic trim of the cartilages (to refine the cartilages) and transdomal suturing of the cartilages (to bring the tip to the midline in a more refine position). 

No need for the longer healing time, scar tissue, excess swelling, and permanent external scar with open rhinoplasty. 

Consult with a surgeon whose 100% surgical practice is closed rhinoplasty. 

All the best!

Deepak Raj Dugar, MD
Beverly Hills Facial Plastic Surgeon
4.8 out of 5 stars 20 reviews

Closed rhinoplasty for bulbous tip reduction

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A closed rhinoplasty approach can accomplish narrowing the bulbous nasal tip. This involves suture techniques and a conservative cartilage removal applied to the lower lateral cartilages of the nasal tip. This accomplishes narrowing and refining the wide and boxy square tip that is present. Once the tip has been refined, the rest of the nose need to be adjusted accordingly along the  bridge line and nasal bones. For more information and many before-and-after results, please see the video and the link below

William Portuese, MD
Seattle Facial Plastic Surgeon
4.8 out of 5 stars 158 reviews

Tip rhinoplasty

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You look like an excellent candidate for at least a tip rhinoplasty. The technique, open versus closed, depends on what your surgeon is most comfortable with. In my opinion, tip changes are most predictable with open approaches and also helps preserve nasal function. Also, it looks like you have some asymmetry to the nasal tip, which would be easier to visualize and correct in an open procedure. 

Sumit Bapna, MD
Columbus Facial Plastic Surgeon
4.9 out of 5 stars 52 reviews

Correcting Bulbous Tip with Closed Rhinoplasty

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Of coarse any rhinoplasty procedure can be done using the closed technique where all incisions are made inside the nose. Having said that, select the surgeon not the technique. Most people who achieve the ideal result by a rhinoplasty specialist using modern techniques don't really care how it was done. 

Richard W. Fleming, MD
Beverly Hills Facial Plastic Surgeon
4.9 out of 5 stars 43 reviews

Bulbous tip

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In truth there are standard poses for rhinoplasty that help us see the nose as a whole. The photos that you supplied are not useful for determining a surgical plan. It does show a close up of a nasal tip that appears wide, but only general statements can be given. Closeups are useless.

Dennis Barek, MD (retired)
Great Neck Plastic Surgeon

Closed vs open

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I prefer to perform an open rhinoplasty to visualize the nose structures directly. In your case it looks like the tip needs to be refined.  

Steven Wallach, MD
New York Plastic Surgeon
4.2 out of 5 stars 30 reviews

Narrowing the nose tip

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Yes, the nose tip can be narrowed through a closed or open technique. In genera, the open technique is more precise. However, you need to know that the dynamics of each nose alteration is very complicated and you need to consult a board certified plastic surgeon who understands those and can explain to you what the consequences of the limited surgery would be.

Bahman Guyuron, MD
Cleveland Plastic Surgeon
4.7 out of 5 stars 23 reviews

Is there any way for my bulbous tip to be rectified with closed rhinoplasty?

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Excellent natural appearing cosmetic results can be achieved with both closed and open techniques. There is not a best way to perform the procedure. Individual surgeons have their own preferences of how to produce the best results in their hands. What is more important than whether a closed or open approach is utilized is the experience and artistry of the plastic surgeon and your comfort level and confidence in that individual.

Following the advice from a surgeon on this or any other website who proposes to tell you exactly what to do based on limited 2 dimensional photos without examining you, physically feeling the tissue, assessing your desired outcome, taking a full medical history, and discussing the pros and cons of the operative procedure would not be in your best interest. I would suggest you find a plastic surgeon with extensive nasal surgery experience who is certified by the American Board of Plastic Surgery and ideally a member of the American Society for Aesthetic Plastic Surgery (ASAPS) or a facial plastic surgeon that you trust and are comfortable with. You should discuss your concerns with that surgeon in person.

Robert Singer, MD FACS

La Jolla, California




Robert Singer, MD
La Jolla Plastic Surgeon
4.6 out of 5 stars 22 reviews


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Thank you for your question and photographs.

I would recommend scheduling a consultation with a board certified plastic surgeon who specializes in rhinoplasty, that way they can perform a physical examination of your nose and give you the most accurate suggestions. Based on your photographs, it appears that your tip is bulbous. You would benefit from a tip rhinoplasty which includes trimming the lower lateral cartilages and placing precision sutures to refine the tip and make it look more pleasing. These incisions can be made discretely on the inside of the nose if an open rhinoplasty is out of the question for you. 
Best of luck in your endeavors!

James Fernau, MD, FACS
Board Certified ENT
Board Certified Plastic Surgery
Member of ASPS, ASAPS, ISAPS, The Rhinoplasty Society, AAFPRS, OTO/HNS, ASLMS, International Federation for Adipose Therapeutics & Science

James Fernau, MD, FACS
Pittsburgh Plastic Surgeon
4.9 out of 5 stars 86 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.