What is the simplest way to reduce the roundness of my bulbous nose? Is it just a matter of taking out some fat? Maybe Kybella?

Question

What is the simplest way to reduce the roundness of my bulbous nose? Is it just a matter of taking out some fat? Maybe Kybella? Or an implant at the end to enhance point? Or something else? Thank you

Suleyman Tas, MD, FEBOPRAS · Answer

Hello,Thank you for your question. Rhinoplasty is one of the most challenging procedures in plastic surgery, and tip plasty is its most difficult aspect. The lower lateral cartilage is (LLC) is the primary structure that is responsible for the shape and function of the ala. I have developed a Novel Technique which is called as Superior-Based Transposition Flap to reshape, relocalize and reinforce the LLC as a support material for both internal and external valves with aesthetic corrections, leaving the scroll area untouched. I use suturing techniques to achieve a narrower, refined and aesthetically pleasing tip. 
Comparing to the open rhinoplasty Closed and Atraumatic technique in Rhinoplasty minimizes swelling and bruises; maximizes healing, prevents tissue damage and eliminates a scar on the columella. To find out more before and after pictures please click on the attached link.
  
Best Regards

Adam Bryce Weinfeld, MD · Answer

It is difficult to provide much advice without photos, but often times a tip rhinoplasty is indicated.  I recommend you schedule a consultation with a board certified plastic surgeon for further advice.  Best of luck.

Jonathan Kulbersh, MD · Answer

It is difficult to advise you without a few photos, but I can tell you that a bulbous nose is usually addressed using surgical rhinoplasty. This procedure can be customized to the precise needs and proportions of each patient. Keep in mind that rhinoplasty is one of the most complex of all plastic surgery procedures. I recommend working with a board-certified plastic surgeon who has extensive experience in nose reshaping. Ask to see many before and after photos of previous patients so you know what you can expect from your own procedure.

Michael Kulick, MD, DDS · Answer

Without pictures or seeing you in consultation, I would be doing you a disservice recommending a specific procedure. If your nasal tip fullness is truly due to fat, using Kybella would be a big mistake! 
There may or maybe not a simple way to have you obtain the result you want other than having you seek a face to face consultation. What you really want is the best result for you and a simple pathway has so many options. During this examination, the doctor can examine your nose and provide you sound advice.  Most of the nasal tip fullness in the cases I performed surgery on was due to the cartilage within one's nose...NOT fat. 
Sincerely, Dr. Kulick San Francisco

Ronald Schuster, MD · Answer

Whoa!! Definitely NOT Kybella! The roundnesss is due to the shape of the cartilage not fat. Kybella only reduces fat. Sometimes you can have fillers placed to hide some imperfections but they typically don't work great to make things "smaller". You will probably need a surgical rhinoplasty to make the changes you want. Go check out a good rhinoplasty surgeon in your area. Good luck.

Jacqueline T. Cheng, MD · Answer

Hello and thank you for your questions and photos.  A bulbous nasal tip is the result of strong nasal cartilages that are sometimes superiorly positioned.  It is not a result of fat so having fat removed will not correct a bulbous nasal tip.  To correct your bulbous nasal tip, you will need to have a tip rhinoplasty that will mostly require cartilage grafts and repositioning your nasal tip cartilages.  You should have an in person consultation with a Board Certified Facial Plastic Surgeon in your area.  Best of luck to you!

Ronald J. Edelson, MD · Answer

I don’t think non surgical options will do much if anything for you.   a rhinoplasty would be worthwhile including lowering your bridge a bit and refining your tip.  Unfortunately because of your thick skin even a rhinoplasty will only do so much.   In a nose like yours I frequently inject the tip with a steroid preparation that will thin the skin out a bit. This may also be worth trying if you decide not to have surgery.   it would need to be done three times a month apart.

Steven M. Denenberg, MD · Answer

There's no significant fat underneath the skin of the nose. To narrow the tip, we modify the strong cartilages that are making it look wide. The woman in the short video that I posted with this answer had the tip of her nose narrowed a significant amount in her rhinoplasty.
When you are figuring out what to do, remember that rhinoplasty is an exquisitely difficult operation to get right, and you should only have surgery if you are able to make yourself very confident in your surgeon's skills. The changes that your nose needs require advanced techniques, requiring skill that most plastic surgeons don't possess with expertise. For most noses, it's much better to not have surgery than to have inexpertly-performed surgery. 
Your nose is also a perfect example of why computer imaging is mandatory in rhinoplasty. You need to know exactly what the surgeon is planning to accomplish -- what features he thinks he can change, and by how much he thinks he can change them. I always email morphs to my online rhinoplasty consultations. When you see the surgeon's goals in the morphs, you'll know whether he has an eye for an attractive nose, and whether he shares your opinion of what constitutes an attractive nose. You'll also know whether the changes he proposes are large enough to be meaningful to you, and whether he understands your wishes enough to address all of your priorities. How would you ever get that figured out without the morphs?

William Portuese, MD · Answer

A closed rhinoplasty approach is going to be required to reduce the bulbous and wide nasal tip cartilages. There is no fat in the nose. Suture techniques and conservative cartilage removal are required during the rhinoplasty procedure to narrow the bulbous nasal tip, however thick skin in the tip of the nose prevents refinement in that area, so it's important to have realistic expectations.

Richard G. Reish, MD, FACS · Answer

Hello and thank you for your question. I do not recommend kybella or an implant. Based on your photographs, you may benefit from a tip refining rhinoplasty. Your surgeon can accomplish this by trimming, suturing, and reshaping the cartilage in your lower nose. 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. You should be able to view numerous pictures of actual patients with noses similar to yours performed by your surgeon. If you cannot find enough real before and after pictures, then consider continuing your search for a surgeon. Best wishes and good luck.

Richard G. Reish, M.D. FACS

Harvard-trained plastic surgeon

Richard G. Reish, M.D. FACS

Harvard-trained plastic surgeon

What is the simplest way to reduce the roundness of my bulbous nose? Is it just a matter of taking out some fat? Maybe Kybella?

Answers (17)

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