What Kind of Rhinoplasty Procedure(s) Would Suit Me?

I really want to get a nose job to get a more shapely nose because I am sick of my bulbous tip. I am just wondering whether that would require any additional techniques? I am kind of afraid of the actual procedure and the risks of scarring.

Doctor Answers 13

Bulbous nasal tip

{{ voteCount >= 0 ? '+' + (voteCount + 1) : (voteCount + 1) }}
Thank you for your inquiry!

It seems that you are a good candidate for a rhinoplasty that will improve the way your nose looks to complement your facial features in a natural fashion. However, without a physical examination it is not possible to provide you with specific details. I highly recommend that you schedule a consultation with a well-experienced surgeon.

It is important to mention that the finest cosmetic results in any particular case are based on a variety of factors, including: the unique anatomy of the patient, realistic expectations, a well-informed and detailed discussion with your plastic surgeon concerning the best options for you especially covering a deep understanding of the pros and cons of any given choice you will adopt.

Please keep in mind that following the advice from a surgeon online who offers to tell you what to do without a physical examination covering the nature and the status of the tissue, assessing your desired outcome, taking a full medical history, and discussing the pros and cons of each operative solution would not be in your best interest. With that in mind, it is the safest and for your best interest to find a plastic surgeon with solid experience and certified by the American Board of Plastic Surgery who is ideally a member of the American Society of Plastic Surgeons that you will trust and be comfortable with. You should discuss your concerns with that surgeon in person.

Good luck!!!

Ali Sajjadian, MD FACS

A rhinoplasty can narrow your bulbous tip and refine your nose.

{{ voteCount >= 0 ? '+' + (voteCount + 1) : (voteCount + 1) }}

Thank you for your question. You're bulbous tip can certainly be refined by rhinoplasty and most likely the nasal bones will need to be narrowed to match your new tip.

If you are concerned about scarring you may want a closed rhinoplasty as opposed to an open rhinoplasty However tip refinement is more accurate with the open approach and the scar is hidden underneath the nose and rarely seen.

Consult several plastic surgeons, insist on seeing there before and after results, and only choose a surgeon who is very experienced in rhinoplasty.

Closed rhinoplasty if external scarring is a concern

{{ voteCount >= 0 ? '+' + (voteCount + 1) : (voteCount + 1) }}

There is no visible scarring when rhinoplasty is performed with the closed technique as opposed to the open technique. All incisions are made inside the nose. The closed technique can significantly improve the bulbousness of the nose and any grafts that may need to be placed can be inserted during the time of surgery. Spreader grafts are usually placed for breathing problems in the mid-third of the nose if there is a valve collapse or vestibular stenosis present or the spreader graft can also be used on the concaved side of the twisted nose. Osteotomies are performed to realign the nasal bones. Most twisted external noses also have a deviated septum and this has to be repaired at the same time as well. This is typically billed with the patient’s medical insurance and is done out of medical necessity. Fixing of the deviated septum is not considered cosmetic. The bulbous tip is addressed for sometimes removal of cartilage. Transdermal suturing techniques and other maneuvers to reduce the bulbosity and feminize the nasal tip.

Rhinoplasty for Bulbous Tip

{{ voteCount >= 0 ? '+' + (voteCount + 1) : (voteCount + 1) }}

Your bulbous tip can be reduced and the definition improved. Seeing just one picture, I cannot tell if anything else should be changed to give you the best possible result. Consult with an experienced rhinoplasty surgeon whose results you like. It is normal to be concerned and nervous when considering cosmetic surgery. 

Richard W. Fleming, MD
Beverly Hills Facial Plastic Surgeon
4.9 out of 5 stars 40 reviews

Bulbous tip rhinoplasty

{{ voteCount >= 0 ? '+' + (voteCount + 1) : (voteCount + 1) }}

First and most important, choose a surgeon who does alot of these and can show you pictures of his successful results ( thats what matters..... talking a good game and fancy credentials can be very misleading) The problem with a bulbous nose is 2 fold and usually a combination of both factors. 1) thick skin 2) very large curvelinear lower lateral cartilages. Most important is to maintain structure or add structure and carefully debulk or thin the skin as needed. Over resection of a bulbous tip makes it droop and look doughy. Thinning the skin and adding structure (cartilage grafts) gives it support and shape which is what you desire and need. Appropriate reduction of the lower lateral cartilages needs  to be done, but should still leave support for the nose and cartilage grafts if done.

Tip Rhinoplasty to Refine Bulbous Nasal Tip

{{ voteCount >= 0 ? '+' + (voteCount + 1) : (voteCount + 1) }}

Hi dor392 in Chicago, IL,

Narrowing a bulbous tip is a common rhinoplasty request, after reducing a hump. Rhinoplasty is not one operation, but rather many potential operations. Tip rhinoplasty typically involves reducing the volume of nasal cartilage at the tip, in addition to bringing the cartilage together with stitches. For patients with thick skin, a small portion of deep tissue may be removed to thin the skin. Cartilage grafts are commonly placed to augment the tip and help in narrowing.

Scarring is a potential risk with any procedure that cannot be avoided. As other plastic surgeons have stated, polly beak nasal deformity may occur from tip rhinoplasty due to several causes. Supratip fullness (pollybeak deformity) may be due to swelling alone, especially very early after rhinoplasty surgery. Excess tip cartilage and/or insufficient tip support, active nasal muscles, and scarring are other potential sources of supratip fullness.

Thick skin usually holds edema and swelling longer than thin skin. The nose will continue to change gradually over time. Some plastic surgeons use nasal taping long after the initial surgery, but most cosmetic nasal specialists found this not to be helpful. Occasionally, steroid injections in appropriate patients may help treat supratip fullness.

Only after a comprehensive evaluation can a rhinoplasty surgeon help determine appropriate options for you. Best of luck.

Rhinoplasty Consultation is your next step

{{ voteCount >= 0 ? '+' + (voteCount + 1) : (voteCount + 1) }}

Rhinoplasty can be a very rewarding procedure for both patient and surgeon, but risks are certainly present and "botched surgeries" are very difficult to attempt to correct with revision surgery. From your question, it sounds like you've been thinking about a nose-reshaping operation for some time. I'd suggest that your next step is to consider searching for a qualified surgeon in your area for a consultation.

For me, communication is the most important part of a rhinoplasty consultation. It sounds obvious, but I don't feel I have completed a consultation if I haven't been able to verify with the patient that we are seeing the same things and both have a clear understanding of both the goals for the surgery AND how we intend to reach these goals. This communication must include:

--Communicate your goals and concerns--your surgeon must be able to fully relate this back to you in language that makes sense to you

--Realistic expectations and limitations of surgery, knowing that there is no such thing as a perfect result

--Chances of re-operation for cosmetic reasons, knowing that revision rates for rhinoplasty are 10-15%

--How challenging your case is and (in my practice, at least), a discussion of each of the likely operative maneuvers that are anticipated and how these relate to achieving your result

--How is your breathing going to be affected, and what steps are taken to prevent having post-operative breathing problems

--Discussion of recovery and the length of time you will have visible swelling

--Reviewing your photographs and photographs of several similar patient's before and after pictures with a discussion of how your case compares and contrasts with these

Selecting a surgeon is a challenging endeavor. If you have a consultation and feel that the above goals have not been met, I'd recommend having another consultation.

When it comes down to a final decision for selecting a surgeon, I'd recommend choosing the surgeon and practice that you would most want to be taking care of you if you were to have a problem or need a re-operation.

Hope this helps

Nick Slenkovich, MD FACS

Kind of Rhinoplasty Procedure

{{ voteCount >= 0 ? '+' + (voteCount + 1) : (voteCount + 1) }}

A FULL rhinoplasty, tip, fractures, hump reduction. Seek in person evaluation from boarded surgeons in your area. Best of Luck.

Tip rhinoplasty

{{ voteCount >= 0 ? '+' + (voteCount + 1) : (voteCount + 1) }}

Tip fullness is a function of several things.  One is the thickness of the skin envelope and the other is the underlying framework. The framework can be changed but the thickness of the skin can not.

What is best surgical approach for a 'Bulbous Tip'

{{ voteCount >= 0 ? '+' + (voteCount + 1) : (voteCount + 1) }}

You have a great question and it is a very common question. Most patients with concerns about their nose tend to fix their attention on only a few issues. It may be a bulbous tip, an overly long/short nose, etc., etc. Sometimes it turns out that the one or two concerns of the patient are all that really is 'wrong' with the nose. Frequently however an experienced Rhinoplasty surgeon will identify associated issues, that if not addressed, will lead to a less than optimal result. An attractive nose depends upon proper balance between all the parts and an experienced surgeon can point out what approach will give the best results. Good luck

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.