Second Opinion for a Bulbous Tip? (photo)

I have gone to a consultation for rhinoplasty on my nose.. My main problems are that I have a large tip and flared nostrils.. My side profile is straight so that doesnt concern me However the surgeon suggested that he will just reduce the tip and not worry about the nostrils as it will create a "pinched" look.. But I think I might need the nostril base narrows as my narrows are quite big Do you have any suggestions?

Doctor Answers 17

Rhinoplasty surgery

I would make sure that you are going to a good board certified surgeon who has a lot of expertise in rhinoplasty surgery. I would suggest looking through the surgeons before and after photographs and reviewing those in particular that are similar to your nose. Ask the surgeon to show you multiple photographs of post surgical patients who have undergone reduction of the nostrils. You may want to get several opinions and see what the consensus is regarding your proposed surgery. It is hard to determine by the photograph provided whether weir surgery is necessary. If you send a photo with a view looking "up the nostrils" and a full facial and profile view I would be happy to give you a further expert opinion. When reducing the nostrils or weir surgery, the nose tip should not look "pinched" when done properly. Best regards!

Orange County Facial Plastic Surgeon
5.0 out of 5 stars 210 reviews

Recommendation for bulbous tip

A bulbous tip can certainly be reduced by tip suturing techniques as well as cartilage removal with a combination of cartilage removal in the nasal tip.  This will feminize and refine the nasal tip to be more in balance with the bridge.  Alarplasty excisions of excess skin at the base of the nostrils can be performed if the nostrils are too wide.

William Portuese, MD
Seattle Facial Plastic Surgeon
4.8 out of 5 stars 145 reviews

Treatment of Bulbous Nasal Tip

The tip can be reduced and definition improved. With the single picture you sent, it is difficult to determine if the base of your nose should also be narrowed. This can be achieved without pinching the tip or causing nostril retraction when done by an experienced surgeon. A more complete set of nasal pictures would help us be more specific in our recommendations. Go to my website for instructions on the submission of photographs.

Richard W. Fleming, MD
Beverly Hills Facial Plastic Surgeon
4.9 out of 5 stars 39 reviews

Second Opinion for a Bulbous Tip? (photo)

Based ONLY upon the posted photo I recommend seeing rhinoplasty PS in person for a full examination. My guess is a tip rhinoplasty with wedge excisions. 

Darryl J. Blinski, MD
Miami Plastic Surgeon
4.6 out of 5 stars 174 reviews

Rhinoplasty can correct a bulbous tip.

Rhinoplasty can correct a bulbous tip and I think that you are an adequate candidate and should expect a very reasonable improvement.

Unfortunately with the block over your eyes I cannot comment on whether your nostrils need to be narrowed because the landmark most surgeons use to determine this is the width between your eyes.

Richard H. Fryer, MD
Salt Lake City Plastic Surgeon
4.9 out of 5 stars 277 reviews

Bulbous nose tip and flared nostrils

From what I can see in the single photo, you are absolutely correct. Your nostrils (alar base) are wide relative to your mouth and rest of the nose. They would be in better balance when made less wide. If only the bulbousness of of the tip is addressed, then the more refined tip will make the nostrils appear even more flared. They both need to be addressed at the same time for a good outcome.

Ramin Behmand, MD
San Francisco Plastic Surgeon
4.8 out of 5 stars 39 reviews

Tip rhinoplasty surgery

From the picture, there seems to be some bulbosity which needs to be addressed. I think a conservative refinement would yield the best result. I would not overdo it. Because we can see your face only partially on this photo it is difficult to assess your nose in the context of your entire face. Therefore, I would tend to approach the nostrils in a conservative way. I would leave them for now and reassess after a few months following tip refinement. Good Luck.

Mark Samaha, MD
Montreal Facial Plastic Surgeon
4.8 out of 5 stars 77 reviews

Alar reduction or not?

Hi there I think your tip is the main problem, and whether you have an alar base resection very much a secondary problem in terms of the aesthetic outcome. By that I mean that you could not achieve an excellent result without remodeling your tip. And in terms of a possible pinched look, that would be due to overresection of the tip not the base. So a careful, aesthetic and functional tip remodeling is the key to a nice result for you. Whether the alar base is resected to reduce nasal base width or size of your nares is more a matter of your own taste. If you're sure it should be done, then it can be done and if you're not sure, leave well alone. It can be done simply secondarily if you decided not to do it, then changed your mind later. Computer imaging might help too to assist you. Good luck.

Second opinion for tip

It's hard to offer advice without seeing your entire face. Many aesthetic "norms' would say that if your nostrils are within your intercanthal distance (lie between the inner corners of your eyes) then they do not need to narrowed. This however needs to be interpreted in context or nostril sill width, flare and your own goals. I would recommend you have some computer imaging to see how it would look either way. When I feel strongly about not doing it I will advise the patient to have tip shaping only initially and let us reassess at 6 months. It is simple to do nostril narrowing in the office under local anesthesia as a second step if still desired. I do not charge extra for this when it is part of the initial plan and there is minimal down time. This doesn't burn any bridges. Nostril narrowing is an irreversible step so be certain if your doctor is advising against it.

Michael L. Schwartz, MD
West Palm Beach Facial Plastic Surgeon
4.8 out of 5 stars 12 reviews


It is difficult to say exactly what you will need without an in-office exam.  However, narrowing your alar base with internal incisions might be helpful.  Make sure you surgeon is boarded in Facial Plastic surgery.

Good luck!

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