Bulbous Tip

Treatment

The term bulbous tip relates to the lower third of the nose being described as excessively round, bulging and/or fat. This is due to the large size of the lower lateral cartilages and exacerbated by thick nasal skin.

Improvement can be made by reshaping the lower lateral cartilages but care has to be taken to ensure excessive cartilage is not removed as this can result in weakness of the side walls (giving rise to secondary problems of nasal blockage) and scar tissue formation causing knuckles to occur (bossa formation).

Techniques to improve the shape of the nasal tip include reducing size of the lower lateral cartilages and use of suture techniques to change the shape of these cartilages. Newer techniques include utilising thin strips of cartilage (lateral crural strut graft) which are placed underneath the curved lower lateral cartilages and by suturing the two together the excessive curvature of the bulbous tip can be refined. Please see before and after sections for examples.

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A number of methods are used to improve the shape of the nasal tip.

Patient Reviews

  • I cannot thank you enough. My confidence has soared and I’ve had so many compliments about my new look. It’s amazing.

    M L
  • My new nose has boosted my confidence level. I chose Mr Patel as I felt that he understood exactly what I wanted from the surgery, and more importantly as I had issues internally with my nose. The surgery went very well and I am extremely pleased with the results.

    H J
  • I would highly recommend Mr Patel He is a fantastic surgeon who levels your expectations and does everything in his power to ensure your operation is successful. He has a formidable reputation and cares about his patients. Since the surgery, my breathing is back to where it was when I was a child. My old nasal voice has now disappeared. Aesthetically my nose is a thousandfold better.

    A T
  • It's looks so natural that people don't even notice that I had an operation. Mr Patel was exactly the specialist I was looking for. On my first consultation, he examined me thoroughly, Mr Patel took his time to explain in detail what the problems were and what options I had, always considering the healthiest outcome. I had my operation and I have already noticed the difference in breathing, which gets better every day. I'm also very happy with my new nose.

    J H
  • After an unsatisfactory result from the first operation at another surgeon when I decided to seek a consultation with Mr Patel. His approaches including confident advice, which is backed by his knowledge and experiences, and detailed explanations about the procedures he was going to go through with the images of CT scan in front of me made me feel convinced of his method during the entire process. The outcome of the surgery was indeed a very satisfactory one.

    P S
  • I was happy with the first consultation as I felt I was in safe hands and as the Doctor explained exactly what was going to be done to me I felt I was making an educated decision. Despite the busy schedule Mr Patel was able to schedule the surgery one month later. The Surgery lasted 3 hours, already that evening I was sent home.

    A N
  • No problems breathing and I am very pleased with the result I was referred to Mr Patel through Bupa and could not have been happier with the experience. The consultations were very friendly and open and I was referred for surgery very quickly. The surgery was explained to me at length and I felt very confident with the process. Afterwards I received a detailed explanation of how it had gone, I recovered very quickly and the aftercare was very thorough. I have already recommended Mr Patel to my friends.

    A R
  • I have suffered from a deviated septum almost all my life. I have always suffered from trouble breathing through my nose, no sense of smell and snoring during sleep so I decided to seek medical advice and was referred to DR PATEL who comes highly recommended. The operation was a great success no bruising around my eyes I was in no pain or discomfort after the surgery. My aftercare has been excellent. I BREATH NORMALLY NOW. I am very pleased with the outcome. I would sincerely recommend Mr Patel.

    K A
  • I would sincerely recommend Mr Patel I consulted Mr Kalpesh Patel. From my first visit, Mr Patel answered all of my questions very clearly and I felt reassured that I was in “safe hands”. He understood my wishes and I felt confident in his abilities. On the day of the operation (a septorhinoplasty), I was impressed by the thoroughness of the procedures and the explanations that were given to me by both Mr Patel and the anaesthetist.

    H S
  • I choose Mr Patel because of his reputation (he was featured in best ENT article in Tatler magazine) and upon meeting his I trusted him, he put me at ease. The surgical experience was very comfortable and went well. I was back at work a week Monday after the operation. My nose is now perfect, back to the way it was before my traffic accident. Mr Patel really understood the situation and how to carefully return my nose to what it was before. The result was excellent, I couldn't be happier.

    C I

Septorhinoplasty can take from one to four hours depending on what is required. Open operations take longer and modern techniques invariably utilise cartilage graft methods. This is particularly the case in revision procedures when harvesting of rib cartilage may also be required.

Most patients are done as day case and therefore will be able to go home towards the end of the day. However, this depends on the individual and if for anaesthetic or surgical reasons there is a need to keep the patient under observation overnight, then this is not usually a problem. Patients who also come from far away may also wish to stay one night for extra nursing care.

In the vast majority of patients, a full general anaesthetic is given so the patient is completely unconscious and is unaware of the procedure. In addition to this, during the operation, local anaesthetic is infiltrated into the tissues which reduces bleeding and gives a degree of postoperative pain control. In rare instances where a very small adjustment needs to be made, this can be done under local anaesthetic with or without intravenous sedation.

Most commonly, painkillers which include nonsteroidal anti-inflammatory such as Diclofenac together with moderate painkillers such as Co-dydramol are prescribed. You may also be prescribed a course of antibiotics, particularly if graft material has been used. An antibiotic ointment such as Bactroban is often given and this is applied inside the nostrils and across the incision in an open rhinoplasty.

Should any changes in your general health occur prior to the operation, you should inform the office of London Rhinoplasty as soon as possible. If an upper respiratory tract infection has occurred, then it is perhaps best to delay surgery until you have recovered from this. On the day of surgery, you will be advised to come to the hospital having been nil by mouth from midnight the night before or at least six hours prior to any operative time given. Nil by mouth means no water as well.

However, you may brush your teeth provided you spit out any water. You should not chew gum prior to the procedure. If you are taking any important medications, please ask for advice as to whether this should be taken prior to the admission time. Although most patients are carried out as day cases, it is always wise to bring a bag with overnight clothes in case discharge has been delayed. Prior to your operation, it is useful to obtain gel packs which can be bought from most pharmacists.

These cooling packs are refrigerated prior and applied to the eyes in the postoperative period to minimise bruising.

You will obviously need to rest after your operation and recover from the anaesthetic and this can take a variable amount of time. Some patients have postoperative nausea and the intake of fluid and foods help to metabolise the anaesthetic agents. You may develop a sore throat as a result of the use of general anaesthetic intubation but these symptoms will usually disappear in seven to 10 days. Use of a throat pack may also result in temporary mouth ulceration.

In the postoperative period, try and sleep a little upright if possible, maybe using a V-shaped pillow to keep you upright. Also use the cold gel packs described above to put gentle pressure over the eyes and minimise the likely postoperative bruising which will occur. You will need to take your medications regularly as prescribed including application of the ointment with a cotton bud.

Instructions will be given to you before departure. It is not uncommon to feel nauseous after a general anaesthetic but if this continues for more than 24 hours with vomiting, then you should inform the hospital where you had your procedure. Facial bruising rises to a peak approximately three to four days after the surgery but by the first postoperative appointment (day 7), much of the bruising will have disappeared. In very rare instances, discolouration around the eyes may remain for a prolonged period of time.

Costs for your surgery include those for surgical fees, fees for the anaesthetist, and those for the hospital facilities. In addition to this, you will be charged for takeaway medications at departure. In instances where biological materials are required for grafting purposes, this will also be charged as an extra. You will be given a quotation from London Rhinoplasty as to the likely costs. In the unlikely event of needing a revision procedure, there would be no extra costs from the surgeon however there will be a fee payable to the anaesthetist and the hospital provider.

This would depend very much on the nature of your insurance policy. Most insurance policies will not cover pre-existing conditions but however if problems have arisen as a result of an injury during the term of your insurance policy, then the costs for treatment will be covered. At the end of your consultation with Mr Patel, a report can be provided which we can send to your insurance company with details of the surgical intervention required and you are then advised to make your own enquiries as to your level of cover. Please note that all charges relating to your surgical treatment is the patient’s responsibility in the event that the insurance company fails to reimburse charges.

Most patients were able to return to work, particularly in the office environment, approximately two weeks after their operation date. However, this is a very individual matter and some may return earlier and some may take longer to make a full recover. You will be seen at weekly intervals postoperatively and final decisions on return of work can be discussed. As a minimum however, you should advise your employer that a period of two to three weeks to make a full convalescence will be required.

Following rhinoplasty surgery, you are advised not to perform any active exercise for a period of six weeks until most of the tissues and bones have healed. Light exercise however is permissible after three weeks but this should not involve any type of weight training.

You are strongly advised to give up smoking approximately a month prior to any surgery and for a minimum period of three to six months following any operation to give you the best chances of healing. There is an adverse effect of cigarette smoking on the healing process, particularly if graft materials are used to reconstruct the nose.

It will be quite rare to operate on a girl under the age of 16 and a young man under the age of 17-and-a-half as until this time the nose has not fully grown. There is also the factor of psychological maturity. There are, however, exceptions to every rule and this can be discussed in detail. At the other end of the scale, there is no actual time limitation for nasal surgery. This would depend very much on the indication for surgery and general medical condition.

At this moment, there is no hard evidence of the benefits of substances such as arnica to help the healing process. However, it is unlikely to interfere with the healing in the postoperative period and therefore patients are permitted to use these herbal supplements if required.

Occasionally, there is excess soft tissue swelling particularly in what is called the supratip area. Subdermal injection of a very small and weak solution of steroid can help to reduce the swelling. The risks of complications using steroid in this manner are small but potential risks include thinning of the skin, formation of prominent veins, infection and increased risk of cartilage absorption. Therefore, careful consideration will be given should this be required.

Please see Patient Information sheets.

Clearly the intention of any nasal surgery is to improve both the aesthetic appearance of the nose and/or the nasal airway. However, operations are not without risk and there is a 5% chance of needing to have a revision procedure. The actual risk of needing further surgery depends on what exactly needs to be done and can therefore be individually assessed. It is strongly advised that a period of time be allowed to elapse so that the final result can be appreciated and this can take anything from 12 to 18 months. Thereafter, any revision surgery can be discussed.