​10 year post op of Septoplasty/Turbinate Reduction, what procedure will refine a thick, bulbous nose with wide nostrils?(photo)

I was never bothered by the size or shape of my nose the last 5 years. I think the tip is fleshy, bulbous and the nostrils spread too much when smiling. My nose also seems out of proportion with my face. I'm not sure whether the bridge is too wide. I am fine with the profile. As background, my skin is oily and thick. 10 years ago I had a non-cosmetic septoplasty and turbinate reduction. I don't want to change my nose entirely, just shrink and refine. Thoughts on a conservative approach?

Doctor Answers 6

Tip refining

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A simple open approach to suture the tip cartilages together can refine the tip.  Adding a tip cartilage can provide further tip projection.  To narrow the tip width, alar resections can be performed.  Best wishes!

Rhinoplasty for bulbous tip reduction

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The bulbous tip is addressed with suture techniques to the lower lateral cartilages to narrow and refine them. Medial and lateral osteotomies of the nasal bones are required to narrow the bridge line. An alar platy is required to narrow wide nostrils, but is performed at rest, not upon animation. The nose will still  widen with smiling due to the facial musculature. 

William Portuese, MD
Seattle Facial Plastic Surgeon
4.8 out of 5 stars 157 reviews

10 year post op of Septoplasty/Turbinate Reduction, what procedure will refine a thick, bulbous nose with wide nostrils?

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The tip can be refined through a closed approach without any visible scars.  The nostril width can be decreased as well.

Kenneth Hughes, MD

Los Angeles, CA

Moderate improvement possible

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Efitz1: Thanks for your question.  I agree your profile is nice.  It is difficult to significantly change the appearance of your nose when you have thick, oily skin.  You can thin the skin somewhat and then refine the tip cartilages and add a columellar strtut and something called a shield graft to further stretch the skin out.  However, these maneuvers would move the tip of your nose further from your face, so you might need additional grafting to the dorsum to keep your nose in balance; this would make your bridge look narrower also, which you would probably like.  Given the prior septoplasty, you probably don't have much usable cartilage from your septum so you might require ear cartilage harvest, which isn't a huge deal. 

It looks like you live just down the road from me, and I would be happy to meet you for a full consultation.  Best of luck. 

Garrett Griffin, MD
Minneapolis Facial Plastic Surgeon
5.0 out of 5 stars 14 reviews

Closed Rhinoplasty for Thick Bulbous Nose

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It is difficult, if not impossible, to substantially thin out the nasal skin from the outside particularly on the tip of the nose. The most 'conservative' way to thin out your nasal tip would be a closed rhinoplasty with tip defatting and cartilage narrowing with nostril narrowing done from the inside of the nostrils.

Bulbous Tip with Thick Skin

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You ask for a conservative approach to treating your bulbous tip. Aggressive treatment by an experienced skin professional (aesthetician or Dermatologist) may reduce the thickness of the thick oily envelope of skin. I frequently have our aestheticians treat patients like you even if they plan on rhinoplasty surgery.

Richard W. Fleming, MD
Beverly Hills Facial Plastic Surgeon
4.9 out of 5 stars 43 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.