One of the most common forms of rhinoplasty requested is the improvement of the nasal tip, especially a ‘bulbous’ tip. Correcting a bulbous nose is one of the most challenging procedures in the already difficult field of rhinoplasty. Refining a bulbous nose requires an experienced surgeon with both artistic sense and technical precision.
The nasal tip (also known as the lobule) must be in harmony with the whole nose and the face and the plastic surgeon must understand the anatomy of the nose before a successful approach can be recommended. Achieving a harmonious and aesthetically pleasing result is one of the most challenging goals for both:
People have a bulbous nasal tip for a number of anatomical reasons, some of which are common to people of particular ethnic backgrounds. In most cases, people want to have nasal tip rhinoplasty that results in a nose in harmony with the rest of the face, while also maintaining cultural identity.
Plastic surgery for a bulbous or wide tip should be considered in the context of the whole nose and face. People consider rhinoplasty for a range of reasons including:
- Correcting impaired breathing, snoring or sleep apnea caused by structural characteristics present at birth – called reconstructive plastic surgery or rhinoplasty
- Correcting structural changes caused by accidents or injuries – reconstructive surgery or rhinoplasty
- Changing the size and shape of the nose (for example, a bulbous tip, wide nose or a dorsal hump) to improve the appearance of the face – called aesthetic surgery or rhinoplasty – including in conjunction with facelift surgery or other cosmetic surgery procedures.
More than any other form of plastic surgery, rhinoplasty is one of the most difficult surgeries. The rhinoplasty surgeon must have the aesthetic and artistic sense to fully understand the way your nose looks and then be able to visualize the final result in advance. The real skill in rhinoplasty is to understand and achieve the client’s wishes. A good surgeon will listen and aim to give the client what they want within the realm of possibility and good aesthetic judgment.
Understanding the anatomical structures of the nose is critical to achieving a good result when refining a bulbous tip.
The appearance of a bulbous tip can be caused by:
- The underlying anatomy in the lower third of the nose (alar cartilage)
- The overlying soft tissue and skin covering the cartilage
- An optical illusion – the tip appears larger because other parts of the nose are not in harmony, such as when there is:
– A low nasal bridge – formed by the bone in the upper third of the nose and cartilage in the middle third of the nose (upper lateral cartilage)
– An overly narrow base of the nose (alar base)
A nasal tip in harmony with the face is achieved when there is a balance between the soft tissues and the underlying structural elements of the nose. Procedures that create aesthetically pleasing highlights and contours around the nasal tip are important to achieve a harmonious result. Tip refinement should give a natural look and not create an overly narrow nasal tip that looks artificial.
Factors that can inhibit a harmonious or balanced nasal tip after rhinoplasty include:
- Too thin or too thick skin
- The strength and position of the lower lateral cartilage (nasal tip cartilage)
- Support provided by the nasal septum – the cartilage separating your nasal passages
- Contraction of soft tissue or nasal tip skin during healing
Your surgeon needs to balance many technical elements with aesthetic considerations and tailor the surgical approach to each client’s needs. This will help to achieve a well-balanced nasal tip and to reduce the risk of the need for revision or secondary rhinoplasty.
One of the most common types of rhinoplasties that Dr Deschamps-Braly performs is correction of a previous surgeon’s work. Revision rhinoplasty is a surgical procedure performed when a nose has had rhinoplasty before, to repair its shape and/or internal function. Revision rhinoplasty is one of the most common of all revision plastic surgeries, partly because rhinoplasty is difficult and clients are not happy with the result.
Revision or secondary rhinoplasty is a much more complex procedure than primary rhinoplasty surgery so proper planning, an artistic sensibility and vast experience is needed to reduce the risk of revision surgery.
Revision rates after nasal tip rhinoplasty can be decreased if the rhinoplasty technique that is employed balances the size of the tip of the nose with the underlying cartilage and overlying soft tissue.
During a consultation, Dr. Deschamps-Braly will listen to your concerns and conduct a thorough physical examination of your nose and photograph you from several angles, including your profile and other features. Bulbous tip surgery requires careful measurement of tip projection and all other nasal dimensions.
Thick skin can tend to mask the underlying surgical changes of rhinoplasty and, if this is the case, Dr. Deschamps-Braly can advise you if a different approach is needed.
Once Dr. Deschamps-Braly fully understands the anatomy of your nose, your facial features and the changes you would like, he will use his vast experience and artistry to design a nose that he believes will give you the best possible result.
Immediately after rhinoplasty, a splint and surgical tape are applied to the bridge of the nose. This splint must be worn for seven days.
You may experience mild swelling and discomfort during this time. Dr Deschamps-Braly takes steps to reduce your pain before the operation, so any pain should be minimal and easily relieved with over-the-counter or non-opioid painkillers. Most swelling usually resolves within 7–10 days.
After just one month, you will see the impact of the procedure, with full results apparent by six months after surgery.
- Rhinoplasty (Nasal Surgery)
- Revision Rhinoplasty (Corrective Nasal Surgery)
- The Art Of The Indian Nose Job (Rhinoplasty)
- The Persian “Nose Job”
- Reshaping of the Broad and Bulbous Nasal Tip. Dhir K and Ghavami A. Clinics in Plastic Surgery, 2016;43:115–126.