The bulbous tip is created from wide and divergent lower lateral cartilages that compose the nasal tip anatomy. The bulbous tip is usually not created from the width of the actual cartilages themselves, but the angulation at which they’re oriented in the nasal soft tissue envelope over the nose. To narrow a bulbous tip, this can be accomplished with either a closed rhinoplasty, or an open rhinoplasty depending upon the surgeon’s preference.
Reduction of the bulbous tip
Dr. Portuese prefers to perform this procedure with a closed rhinoplasty approach, whereby all of the incisions are placed completely on the inside of the nose. To narrow the cartilages requires a combination of inter-domal and intra-domal sutures, which narrow them individually, and then narrow them together as a unit. Once the cartilages had been narrowed, some patients also require a conservative cartilage removal as well on the sides of the nasal tip. Removing the cartilage also helps narrow and refine the nasal tip. This is considered a cephalic trim removal of the lower lateral cartilages of the nasal tip. In addition, cartilage grafts can be placed on the top of the nasal dome where the sutures have been placed to give added projection to the tip when needed. This cartilage grafting is helpful in patients who have moderate thickness of the nasal tip skin and poor projection of the tip.
After the cartilage grafts and sutures have been placed, the cartilages are then reinserted back into their normal anatomical position, and the incisions closed with dissolvable catgut sutures. It takes several months to start to see what the new nasal tip looks like due to the swelling that occurs in the area of the nasal tip, which is prolonged. Full healing after a rhinoplasty procedure is one year. When patients have thick skin in the tip of the nose, this is a significant impediment to seeing a very refined result over the nasal tip cartilages. Patients who have thick skin in the nasal tip are poor candidates for open or closed rhinoplasty. Many patients also require taping of the nose in the first 6 months after the procedure, and some patients require cortisone shots to help prevent buildup of fluid and scar tissue in the supratip area of the nose. Follow-up with your operative surgeon is of utmost importance, and is just as important as the surgery itself.
Dr. Portuese performs bulbous tip reduction rhinoplasty at the Seattle Rhinoplasty Center located in Seattle Washington.