Bulbous tip - why wouldn't a revision surgery help? (photos)

Question

Hello. I am a 2nd year medicine student. I have had one rihnoplasty done in 2021, however by nosetip has dropped significantly. It was of the bulbous type, and I have been told from my surgeon that I have a "very thick skin", and that a revision surgery couldn't help me any further. However, if I'm at all correct, the cartilage in the nose of the hyaline type which is avascular? Why would it then be a problem to remodel it by simply cutting it off, and reshaping?

Selcuk Inanli, MD · Answer

Hello! Thank you for your question. As far as I can see from your photo your surgeon is right you have thick skin but with the revision surgery your nose tip will be improved. With the revision surgery you may have more upward and thin tip. It would be more convenient to decide with face-to-face consultation. Best Regards!

Charles East, MBBS, FRCS · Answer

Hello,A drop of the nasal tip after surgery usually means a weakened support and is a common reason for revision surgery, Your images appear to show relatively normal skin so repositioning/ restructuing for a better shape would need a consultaion with a specialist rhinoplasty surgeon.Revisions are usually considered around 12 months after the last operation.

Celal Alioglu, MD · Answer

Hello you need make a small projection of your nose little need to up tip of the nose and make a straight your septum

Eric M. Joseph, MD · Answer

Revision rhinoplasty may be exponentially more difficult than primary rhinoplasty, so if your nose looks improved, your surgeon may be skittish. Thick oily nasal tip skin does affect the amount of narrowing that can be achieved with rhinoplasty, so seeing your B&A photos may be helpful. Try not to worry about your nose, and keep studying! Thanks. Dr Joseph

Ronald J. Edelson, MD · Answer

I think your result is quite good. There are simple techniques to raise the tip if the nose is too long. But from your photos I don’t see the need. Perhaps it’s different when looked at in person

Robert Ciardullo, MD · Answer

Revision of drooping tip: there are at least three separate issues to discuss here. A drooping tip means that the angle your tip makes with your upper lip is too small. A tip can be elevated as a separate procedure. A bulbous tip is a wide or broad tip which may be due to large broadly shaped Cartilage and /or thick skin of the tip. If you wish to make your tip thinner it might be possible to trim the Cartilage some more. If the thickness of the tip is due to thick skin, trimming the Cartilage will not help, but some surgeons might inject a small amount of Cortizone But it is not clear to me whether you wish to lift your tip, or make it thinner, or both.

William C. Harris, MD · Answer

Hi,
Nasal tip drop following rhinoplasty is always anticipated to a certain degree, however, if not suspended in a permanent fashion this can be more than desired over time. I don't have a full sense of what all was performed in your previous surgery, but I don't see any reason why a revision rhinoplasty wouldn't be able to be tailored to give your tip additional rotation. There are also several surgical techniques that can be used to address thicker nasal skin as well as medications like accutane prior to surgery to help reduce the thickness of the skin. I hope this helps and please reach out if I can be of any assistance with your goals.

Jeffrey C. Hamm, MD - Account Suspended · Answer

Hi and welcome to our forum!
From your photos, I note that your nose is relatively midline, your nasal bridge is straight and of appropriate height. There appear to be external well healed scars at the alar creases. Your nasal skin is relatively thick, manifested photographically by the presence of exaggerated nasal pores, tissue thickness at the nostrils, and blunting of delicate features.

Although hyaline cartilage is avascular, its nutritional needs are provided by the overlying perichondrium. Stripping the cartilage from surrounding tissues is often performed, allowing it to be replaced as a cartilage graft which will then receive nourishment from overlying / underlying soft tissues. Realigning / removing / replacing cartilage with reapplication as a free graft is often accomplished in nasal surgery with satisfactory results.

Unfortunately, there is no procedure to satisfactorily correct thick nasal skin, but most patients with thick skin who undergo rhinoplasty are still satisfied with the improvement achieved with the operative result. 
Best wishes...

Bulbous tip - why wouldn't a revision surgery help? (photos)

Answers (8)

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