Unlike regular rhinoplasty, in which portions of tissue are removed to help slim and refine the contour of the nose, bulbous tip rhinoplasty reshapes the cartilage of the nose to reduce convexity. Therefore, while trimming excess cartilage can help if the cartilage is too wide, if the cartilage is too convex a different procedure is necessary.
If the cartilage is strong enough to support such a method, dome binding sutures can help to flatten this cartilage. With this method, the surgeon places permanent sutures throughout the dome region of the nose. This serves to narrow both sides of lower lateral cartilage. By pulling opposing cartilage on either side of the nose together toward each other, the shape of the nose can be streamlined and an excessive arch along the tip can be reduced.
If, on the other hand, the upper edge of the lower lateral cartilage is too wide, a procedure called a cephalic trim can indeed help reshape it. This technique may be performed by itself or as part of a larger nasal reshaping procedure, all aimed at reducing to eliminating a bulbous tip.
Sometimes, however, dome binding sutures aren’t supported, or if even if they are, might not be sufficient to fully correct the problem. In these cases alternative or additional measures can be taken. One such measure is a cartilage graft, called a lower lateral crural strut graft, which can be inserted beneath the cartilage to provide additional flattening support. A third technique using similar technology is a lateral crural overlay.
That said, in some cases standard tip defatting is all that’s needed to refine the bulbousness of the nasal tip. If a fibrofatty pad is too prominent in the nasal tip, causing this appearance of bulbousness, then simply reducing it can help to refine the nose’s appearance. Even in cases where other rhinoplasty methods are used to reduce a bulbous nasal tip, fibrofatty pad reduction could be used as an additional, supporting technique to further refine results.
When considering rhinoplasty for your bulbous nasal tip, be aware that slight prolonged nasal swelling following surgery could occur, lasting from several months to several years.