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Home / Bulbous Nasal Tip

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 One

Anatomy of the Cartilaginous Bulbous Tip

Over-developed, Over-projected Lower Lateral Cartilages.

Bulbous Nasal Tip

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.

Bulbous Nasal Tip Correction

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.

Bulbous Nasal Tip Correction NYC

Bulbous Nasal Tip Correction NYC

Bulbous Nasal Tip Correction NY

Bulbous Nasal Tip Correction Manhattan

Bulbous Nasal Tip Correction Manhattan

Bulbous Nasal Tip Correction

Bulbous Nasal Tip Correction

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

Bulbous Nasal Tip Correction

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.

African American Bulbous Nasal Tip Correction

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

African American Bulbous Nasal Tip Correction

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 Nasal Tip

Bulbous Nasal Tip

Bulbous Fatty Tip

Bulbous Nasal Tip

Bulbous Nasal 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.

Bulbous Nasal Tip Correction

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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Oleh Slupchynskyj, MD, Board Certified Facial Plastic Surgeon
44 East 65th Street, New York 10065 (212) 628-6464
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Cosmetic Facial Plastic Surgery in New York and New Jersey