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What Causes a Bulbous Nasal Tip

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 1

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 2

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 3

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.

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  • I am so thankful to have come across Dr. Oleh Slupchynskyj of The Aesthetic Institute of New York & New Jersey. "Dr. S." (as I like to call him for obvious reasons, haha) is a Board Certified Facial Plastic Surgeon, and it turns out he has an entire website dedicated to his work with African-American patients: www.africanamericanrhinoplasty.com. I was immediately impressed with the wealth of information that he has on his site, including information about his practice, his stellar credentials, his surgical inventions (i.e., the SLUPimplant™) ...

  • I was terrified of having surgery but after two consultations with Dr. S., my anxiety was alleviated, and this was my biggest hurdle. I was able to see what my results would be after surgery through "computer imaging". He spent as much time with me as needed and said I could come back as many times as I wanted before making a decision. That was refreshing. I asked to speak with at least 3 other patients of Dr. S. and did. They shared my initial fear and they helped me by explaining their experiences from a patient's point of view! Dr. S. specia...

  • The doctor is very approachable and personable and I felt that he is really listening to me. He made every effort to be easily accessible via email or phone. He also followed me every step of the process, not only during the surgery but also during the recovery period.

  • Board Certified with specialized training and loads of experience in Nose Surgery. I was able to see and discuss my results beforehand thru computer imaging so I felt very comfortable with what my result would be. Having consulted with other Drs. who did not have same training, imaging and were twice the surgical cost, I made my decision.

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    I am a 27 year old, African-American female from the Midwest and I just recently had a Rhinoplasty procedure performed on February 9, 2012. I had known for a long time that I wanted to have the procedure done to correct a bump in the bridge of my nose, reduce the width of my nose, as well as to refine my down-turned nasal tip. This was an operation that I was not going to trust to just anybody, so I spent countless hours researching and looking for a surgeon who had significant experience working with African-American patients. Because I liv...
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