Scared to get a nose job because I have a bulbous nose. Is there any procedure/method to prevent a round undefined nose? (Photo)

Question

Hello! So besides straightening my crooked nose and lifting it upward, my main concern in the bulbous tip. I would like to define the tip of my nose but I'm scared the results will come out very swollen looking. From pictures I've seen, some rhinoplastys on bulbous noses makes them smaller but also very rounded and swollen looking even after 1 year (I inserted some pictures). Is there any procedure/ method to prevent the round undefined nose... or is it just a hit or miss?

Ronald J. Edelson, MD · Answer

You can get a refined look to your tip but trimming and reshaping the cartilage. You also need the tip lifted quite a bit to avoid a hanging columella.

Nima Shemirani, MD · Answer

Hi @Amaralovesyou! Thank you for sharing your photos. I recommend seeing an expert rhinoplasty specialist for in person examination. There are several options for you that can be determined after examination. A rhinoplasty in my opinion is one of the most difficult procedures to perform. The skill, artistry, and technique of the surgeon will determine the outcome. In my practice, I utilize piezosurgery. Piezosurgery is a more gentle technique that allows for greater precision. Less bruising and swelling is common with Piezosurgery. In a typical rhinoplasty, a hammer and chisel technique is performed leading to more inadvertent fractures. Best wishes, Dr. Nima!

Caner Kacmaz, MD · Answer

Thank you for your question i would recommend operation using the latest Ultrasonic Rhinoplasty device Piezo®: 
In traditional Rhinoplasty, surgical instruments known as rasps and osteotomies (hammer and chisel) are used to reshape the nasal bones by removing the hump and/or narrowing the nasal bone width. These tools are relatively imprecise and their use can lead to contour irregularities, etc. if not used in the proper manner. Recently, a technology that uses sound waves has been developed to contour nasal bones in a precise and far less traumatic way when compared to traditional techniques. Ultrasonic, or Piezo, Rhinoplasty is now the most advanced technology available for minimally traumatic nasal bone reshaping and hump removal during Rhinoplasty. There will be hardly any bruising and swelling which will make the recovery period a lot easier for the patient.

Edwin F. Williams, III, MD · Answer

A bulbous tip is one of the most common reasons people seek a rhinoplasty operation. There are many techniques that can be used to refine the tip. The thickness of patients' skin has the potential to limit the amount of refinement, however surgery is still certainly an option.

Stephen J. Pincus, MD · Answer

A "bulbous" appearing tip may result from strong tip cartilages under thin skin, weak tip cartilages under thick skin and all variations in between. The techniques commonly used involve shaping the tip cartilages with or without overlying  cartilage grafts. The decision to do a particular technique depends on the surgeon's examination during his consultation, and what his experience is with what would work best given those findings. So you should see several surgeons who are experienced doing this procedure and look and his before & afters of patients who had similar noses to yours.

Gary Linkov, MD · Answer

Rhinoplasty requires exceptional skill on behalf of the surgeon and great communication with the patient about realistic goals and expectations. Common cosmetic concerns include a dorsal hump, wide nose, sunken nose, irregularities, and asymmetries. Functional concerns include difficulty breathing through the nose, which can and should be addressed at the same time as your rhinoplasty.

In your situation, the bulbosity can be best removed by flattening the lateral crura. This can be done in several different ways.

Make sure to seek out the care of a board certified surgeon with extensive experience in rhinoplasty. Find someone you connect with, who will listen to your concerns and provide you with a framework for what is possible.

Gary Linkov, MD 
Rhinoplasty Specialist 
Manhattan

Toby Mayer, MD · Answer

Rhinoplasty for bulbous tip etc. with definition. Your skin appears only slightly thick and can be thinned to prevent a polybeak. See a very experienced rhinoplasty surgeon who can show you natural results in noses like yours and don’t rely on imaging!

Victor Manuel Agudelo, MD · Answer

What limits a result on a bulbous tip work, is when patients have a thick skin, but definitely this is not your case. You seem to have strong and wide  cartilages, that can be trimmed , sutured and reshaped to give you an adequate narrowing and definition.

William Portuese, MD · Answer

A closed rhinoplasty approach can accomplish reduction of the bulbous tip, lifting the nasal tip itself, and reducing a hanging columella.  It is important to release the depressor septi ligament which pulls the tip down dynamically when smiling.  Digital computer imaging be helpful to understand what can be accomplished with a rhinoplasty procedure upon your facial features

Robert Singer, MD · Answer

Every nose is different and unique to that individual. If the appearance of your nose concerns you enough to do something about it, it can be improved with a natural artistically performed rhinoplasty. What would be the best option and exact procedure would depend on an in person examination (not just an online consultation) and discussion about desired outcome. Excellent results can be achieved with either a closed or open technique.

Keep in mind that following advice from a surgeon on this or any other website who proposes to tell you exactly what to do and how technically to do it based on limited photos without examining you, physically feeling your tissue, assessing your desired outcome, taking a full medical history and discussing the pros and cons of the operative procedure would not be in your best interest. Natural appearing results need to be individualized and what is appropriate for one patient is not necessarily the best for someone else. I would suggest that you find a surgeon with extensive rhinoplasty experience certified by the American Board of Plastic Surgery and one who is ideally a member of The American Society for Aesthetic Plastic Surgery (ASAPS) that you trust and are comfortable with. You should discuss your concerns with that surgeon in person.