Correction of a Bulbous Nasal Tip remains one of the most challenging aspects of Ethnic Rhinoplasty. The Bulbous Nasal Tip can be divided into three different types. One type is the Cartilaginous Bulbous Tip that is typically found in Caucasians. This Cartilaginous Tip is primarily due to over-developed and over-projected Lower Lateral Cartilages. The skin is usually thin and overlies the cartilage giving it a bulbous appearance. Correction of this type of tip requires re-sculpting of the Lower Lateral Cartilages using several different techniques including dome division, cephalic strip, septal strut, and shield grafting. These maneuvers not only remove the bulbosity of the tip but also can nicely rotate and de-project the over developed tip. Dr. Slupchynskyj likes to address the Cartilaginous Bulbous Tip through an Open Rhinoplasty approach. He uses a combination of dome division, cephalic strip, septal strut, and shield grafting to reshape the Cartilaginous Bulbous Tip and bring it back into a pleasing aesthetic proportion to the rest of the face.
Anatomy of the Cartilaginous Bulbous Tip – Type One
Over-developed, Over-projected Lower Lateral Cartilages.
The photo on the left reveals over-projected, overdeveloped Lower Lateral Cartilages that create the Cartilaginous Bulbous Tip. On the right, Dr. S. has reconstructed the Lower Lateral Cartilages during an Open Rhinoplasty procedure. He performed a dome division, cephalic strip and strut grafting to reduce the Bulbous Tip effect.
The photo on the left shows over-projected, overdeveloped Lower Lateral Cartilages that create the Cartilaginous Bulbous Tip. Photo on the right shows how Dr. Slupchynskyj reconstructed the Lower Lateral Cartilages through dome division, cephalic strip and strut grafting, which reduced the Cartilaginous Bulbous Tip appearance.
These patients are shown before and after Cartilaginous Bulbous Tip Reconstruction with Dr. Slupchynskyj.
Anatomy of the Bulbous Tip from Thick Skin, Fatty Tissue and Weak Lower Lateral Cartilages – Type Two
The second type of Bulbous Tip is usually as a result of thick skin and fatty subcutaneous tissue in combination with small weak underlying cartilages. This type of Bulbous Tip is typically found in Ethnic patients such as African Americans, Hispanics and Asians; however, Caucasians can also exhibit Fatty Bulbous Tips. This type of Bulbous Tip is more difficult to refine. Not only does the surgeon need to add supporting tip cartilage such as a septal strut and shield grafts but also needs to meticulously remove subcutaneous fat and trim the subcutaneous skin. This can only be done through an Open Rhinoplasty. Dr. Slupchynksyj perfected this procedure using a three-tiered Ethnic Rhinoplasty technique, which involves cartilage support grafts, defatting the bulbous tip, and addressing the dorsum and alar width through a combination of Alarplasties. In addition, these patients may require Kenalog Injections immediately following surgery to prevent any possible scar tissue formation.
Bulbous Tip From Thick Skin, Fatty Tissue, Weak Lower Lateral Cartilages
The image above compares and contrasts a typical Caucasian nose intra-operatively with an Ethnic nose that has a Bulbous Nasal Tip caused by thick nasal skin, fatty tissue and weak Lower Lateral Cartilages.
On the left, Dr. Slupchynskyj is shown de-fatting the nasal tip of a Bulbous nose. On the right, a different patient is shown with the excess fat already removed and placed in its approximate anatomic position on the nasal tip.
Intra-operative view of Defatted Bulbous Tip and Cartilage Grafting
On the left, the Bulbous Nasal Tip is shown intra-operatively. The weak cartilage and fatty fibrous tissue are circled. On the right, the same nasal tip is shown defatted and with a cartilage graft to support and further refine the nose.
These patients are shown before and after Ethnic Rhinoplasty for a Bulbous Fatty Tip.
Bulbous Tip From Scar Tissue in Tip Resulting from Previous Rhinoplasty – Type Three
The third type of Bulbous Tip arises from a poorly executed previous Rhinoplasty. Dr. Slupchynskyj sees many patients with a Bulbous Tip who experienced this undesirable result with another surgeon leaving them with more scar tissue in the tip; this exacerbates the already bulbous nature of the tip and requires a revision. In these Revision Rhinoplasty Bulbous Tip cases, the scar tissue must be removed and a combination of cartilage grafting and skin thinning must be performed. These patients will also need a series of Kenalog Injections to prevent further scar tissue reformation.
This patient is shown before and after Revision Rhinoplasty with Dr. Slupchynskyj correcting a Scar Tissue Bulbous Tip resulting from a previous Rhinoplasty with a different surgeon.