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?

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

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.

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. 

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

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.

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!

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.

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?

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
 

Hello and thank you for your question.  Although an exam in person is ideal, from your photographs alone it appears that you can benefit from a tip rhinoplasty where the nasal tip cartilage is modified for a more refined, and less bulbous look.  To answer your point about taking out fat -- yes, one of the components of the surgery may involve thinning of your nasal tip skin with minimal excision of fat, but would likely primarily involve cartilage excision, suturing and grafting.  I would not suggest any injection of Kybella into your nose.  If your septum is deviated and you have breathing difficulty, a septoplasty may benefit you as well.  The next step for you is to find the right aesthetic plastic surgeon.  In your rhinoplasty consultation, be sure your surgeon addresses all your aesthetic goals and concerns specifically, and discusses the surgery details including the position and size of the incisions used (with actual photographs and not just digital animations), the risks and benefits of the procedure, recovery time, and post-operative course.  Also, be sure to see plenty of before-and-after pictures in women who have a similar nose appearance to yours, and preferably at different time frames (3 weeks out, 3 months out, etc) to more accurately predict your own surgical outcome.

After seeking out a board-certified plastic surgeon who specializes in aesthetic plastic surgery, I think the most important component of the consultation is to establish a good connection with your plastic surgeon.  It’s the connection that allows you to clearly define your desired nose outcome goals, the first step of this whole process. If you don’t feel you have a good connection with your plastic surgeon after your consultation, he/she may not be the best surgeon for you.

For more information on rhinoplasty, please refer to the link below.

Good luck.

Mark K Markarian, MD, MSPH, FACS
Harvard-trained Board Certified Aesthetic Plastic Surgeon