Thick skin rhinoplasty for bulbous tip? (Photo)

I know, the photos aren't highly detailed, but I believe I can see the contours of your wide tip cartilages, which means that most of the excess width of the tip of your nose is due to the cartilage, not thick skin.If that's the case, then your tip can be narrowed, by working on those tip cartilages. The strong tip cartilages are making your tip look wide, and also holding the tip down on the profile view. Perhaps elevating the tip a little bit would help as well.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 -- complicated work on the tip cartilages --require advanced techniques, and 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. Read my essay on how to stay out of trouble while selecting a rhinoplasty surgeon. And it also discusses how to take photos that are best for online evaluations.
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?

A bulbous tip is one that is too round and broad. Bulbous tips are seen very frequently by experienced rhinoplasty surgeons. There are predictable techniques that can improve the shape and size. Thicker skin tends not to show as much fine definition but should not interfere with changing the size and shape. Good luck.

Dear loola916,Based on your photos you would be a good candidate for an open or close rhinoplasty. People make a big deal about open versus closed but they are both established techniques and the main difference is just a small scar at the base of your nose that is usually invisible to the naked eye. Consult with a board certified plastic surgeon to learn more. Good luck,Nirmal R. Nathan, M.D.

·      Certified, American Board of Plastic Surgery

·      Member, American Society of Plastic Surgeons

·      RealSelf Top Doctor

Hello and thank you for your question. 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. You may also benefit from an alar base reduction and soft tissue debulking of your nasal tip.  This can be done with either open or closed technique.  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
 

Based on the pictures you send, I can tell you that you are the right candidate for refining rhinoplasty surgery to have a reduction and better definition on the tip of your nose. This kind of results can be achieved either with a close or open rhinoplasty; it will depend on the surgeon’s expertise and criteria. Thick skin can limit the results when it comes to the definition of the tip in rhinoplasty, but that is something that is hard to say just based on pictures, so for me, the best recommendation that I can give to you is to get a consultation with a board certificated plastic surgeon with experience in rhinoplasty so he/she can tell you which is going to be the best option for you.

Hi and welcome to our forum!From your photos, I note a rounded bulbous nasal tip. There appears to be a pitted appearance of the skin suggesting exaggerated pores and thickened skin.The presence of thick skin somewhat limits the result of rhinoplasty, especially at the tip. If one puts up a tent frame and covers it with a sheet, it will take the shape of the frame. If one places a mattress over the frame, it will hardly fold at all. In my experience, the procedure is still worthwhile as although the result may be somewhat limited, there should still be a degree of improvement in nasal tip contour. Best wishes...

Hello. 
The issue with a bulbous thick skinned tip is that it cant be narrowed and defined as much as with patients having medium or thin skins. But you can have a visible and positive change, as long as you have realistic expectations, based on computer imaging and at similar cases as yours performed by your doctor.