Bulbous Tip Nose Surgery in New York
Dr. Oleh Slupchynskj, MD
Bulbous: An adjective meaning round and swollen looking. Bulbous nose? You guessed it: A round and swollen looking nose.
Many patients come to see me for consultation about their bulbous nose. Some patients say the tip of their nose lacks definition or support; others say that their nasal tip needs to be more refined or less round. While the language used to explain this type of nose can vary, these descriptions all allude to the structural differences that result in a bulbous nose. Most common in patients with an Ethnic background such as African-American, Asian, Middle Eastern, and Hispanic patients, but found in Caucasians, the right surgeon can successfully correct a bulbous nose.
A bulbous tip can become the central focus of face taking away from other features such as nice eyes, lips, cheeks, etc. Reshaping a bulbous nose can restore the facial harmony and balance that creates attractiveness of an otherwise beautiful face.
What is it about the bulbous nose shape that may be aesthetically undesirable for some? To answer these questions, we need to look at facial balance and symmetry. From the frontal view of the face, the nose should have 2 divergent, concave lines that extend from the medial brow to the nasal tip (like an hourglass shape). This is known as the brow-tip aesthetic line. See patient photos below. Excessive fullness in the nasal tip disrupts the balance of this line.
Anatomy of the Tip and Bulbous Tip.
The tip of the nose primarily comprises of skin, subcutaneous fat, cartilage, connective tissue, blood and lymphatic vessels, sebaceous glands and mucosa. Anyone of these tissue layer can contribute to bulbous tip formation; however, primarily bulbous tips can be attributed to skin thickness, subcutaneous fat and/or cartilage. As you will see, anyone of these layers can be responsible for bulbous tip formation. The appropriate surgical approach and techniques must be employed to reduce bulbous tip appearance.
The Lower Lateral Cartilages can be further broken down into their medial (towards the midline), lateral (away from the midline) and cephalic (closest to the top of the head) ends.
We will discuss 3 general types of bulbous nose, as I define them. Not all bulbous noses fit easily into one of the 3 categories, but these basic divisions can provide a framework from which to discuss their causes and differences between each type of nose.
Lower Lateral Cartilages
In Non-Caucasian, Ethnic patients there are distinct anatomical differences that dictate the need for a variety of surgical approaches to correct bulbous tip formation.
Anatomical Differences Between Caucasionoid and Ethnic Noses.
1.) Nasal Bridge height is different. Typically lower in Ethnic patients.
2.) Thicker skin and more fibrofatty tissue in Nasal Tips of Ethnic patients.
3.) Weaker / Flimsier Tip Cartilages in Ethnic Patients.
4.) Nostrils are wider and more flared in Ethnic patients.