My Nose is Bulbous and Nasal Tip is Overprojected Due to Fat, What Can Be Done to Improve It?

Question

I am indian and have thick skin.However I think my nose is bulbous because of fat under the skin and not the skin itself.

Giancarlo Zuliani, MD · Answer

Rhinoplasty in individuals such as yourself is quite tricky. The first reaction that patients often have is to make the nose smaller, however, this can be disastrous if you do not visit a board certified surgeon who has done a fair amount of ethnic rhinoplasty. As the skin color darkens the cartilage in the nose becomes more amorphous and less rigid. This combined with the greater percentage of sebaceous glands makes the nose seem flat and bulbous. To correct such deformities an open structure rhinoplasty is often the best to make the nose more rigid and to ensure proper function. In seems counter-intuitive but making certain parts of the nose more prominent balances the whole nose and facial aesthetic. It is important also to not lose all semblance of your ethnicity as well as this can be a tell tale sign of cosmetic surgery. Good luck!

Toby Mayer, MD · Answer

This can be done but I would need to see photos to say how much refinement you can expect. Fat and excess cartilage can be removed but not the skin.

Anand G. Shah, MD · Answer

Hi there.  Rhinoplasty (nose reshaping surgery) to address a bulbous nasal tip is a feasible maneuver.  Most likely, an “open rhinoplasty” (where the soft tissues are gently elevated to allow direct access to the tip cartilages) will be required.  These tip cartilages are then sculpted and sutured to refine the nasal tip.If you like, please follow the link below.  The article on Nasal Analysis contains many diagrams that you may find helpful.  This may help guide your conversation with your surgeon.Hope this is helpful.  Best wishes.

William Portuese, MD · Answer

There is no fat in the tip of the nose. The nasal tip is simply composed of very thick oily skin and wide thick cartilage. To change the nasal tip, a portion of the tip cartilage can be removed. The remaining portion provides structural integrity to the nasal tip and will then be sutured together to narrow and refine the tip. This is also known as a tip plasty procedure. This will reduce the bulbous portion of the nasal tip, but it is important to make sure that the tip is in balance with the remainder of the nose.

Robert Kotler, MD, FACS · Answer

I assume you have not had prior surgery, correct?

	If that is true, and your surgeon told you that your problem is excess fatty tissue and not bulbous cartilages and not thickness of the tip skin itself, consider a non-surgical technique.

	Ask your surgeon about injecting a cortisone solution under the skin to thin the fat layer.

	This is not an unorthodox technique. It has been done by many surgeons for many years. There is a best concentration and volume to use, and it must be done artfully, of course. But, it can be quite impressive.

	Worth a try , right?

	Best of luck.

	-Robert Kotler, MD, FACS

	Author, SECRETS OF A BEVERLY HILLS COSMETIC SURGEON

Michael L. Schwartz, MD · Answer

Patients such as yourself do present challenges in rhinoplasty. Typically a combination of defatting and thinning of the skin along with creation of a strong cartilage framework to impart structure to the skin will yield improvement in shape. Keep your expectations realistic though, you will likely never have a small delicate and refined nose.

David A. Bray, Sr., MD · Answer

I believe all of us surgeons believe that thick skin or fat under the shin impairs tip refinement. Trying to thin skin or remove fat results in scar tissue. However there are procedures on your tip that will improve things

Shepherd G. Pryor, MD · Answer

In my experience with patient's with slightly thicker skin and denser fat in the nose there is less that can be accomplished in refining the nose compared with those that are thin skinned. However, it is definitely acheivable to refine your nose in a variety of different ways. Typically, most patients benefit from a combination of both reductionist and augmentation techniques to both take away from areas that are too broad or full and add to other areas (such as the nasal tip) to create more projection, more refinement and more definition. This is essentially a maneuver to add structure, thus making the outer covering appear less present. A good analogy is that currently your nasal skin may act like a duvet (pillow) cover on your bed. If you were to hide a child's toy underneath this we may know there is something under there but not exactly what. By adding structure we are inherently stretching out the skin and underlying fat so that it is more like a single sheet on the bed covering the toy. Now we can really see the angulation, the curves, the new structure underneath as it becomes more prominent. Again, we are not just giving you a bigger nose, but creating a work around solution for the thick nasal skin issue. Make sure your surgeon completely understands this concept and doesn't just attempt to give you a smaller nose by taking away structure and defatting the skin or thinning the skin itself. That doesn't work. Hope that helps!

Francis R. Palmer, III, MD (retired) · Answer

No, the nose doesn't have a fatty layer capable of making the tip appear broad, wide or bulbous. These characteristics, of the nasal tip, are due to tip cartilage shape, subcutaneous tissue (not fat) and thick skin. IMHO, you should send photos for evaluation, of your nose, or have Rhinoplasty consultations with experienced Rhinoplasty Surgeons.

Richard W. Fleming, MD (retired) · Answer

Although certainly possible, a bulbous tip is usually not secondary to fat but thick skin with poorly defined, weak tip cartilages which can be strengthed with the actual addition of cartilage to improve the tip contour. With rhinoplasty we always change the underlying structure of cartilage and bone but it is difficult to change the overlying envelope of skin and effectively remove subcutaneous fat.

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