Correcting a Bulbous Nose with Rhinoplasty

Written by Minas Constantinides, MD, FACS, Board Certified Facial Plastic Surgeon on January 11, 2022 No Comments

bulbouse nose correction

A bulbous nose refers to a broad appearance to the tip. While varying in severity, a bulbous nose can severely alter one’s appearance by creating facial disproportion. Bulbous nose surgery, a subsegment of Rhinoplasty, is a cosmetic surgery which resizes or reshapes the nose.

If you suffer from issues stemming from a bulbous nose (bulbous tip), here’s how a bulbous nose focused rhinoplasty procedure can help

What Causes a Bulbous Tip? 

A bulbous tipped nose may be a lifelong feature, or something that worsens with age. When the tip of the nose is round and wide, it could be a result of the following:

  • Poor cartilage strength
  • Cartilage spaced too wide
  • Rounded cartilage which creates a dome shape
  • Cartilage with too much ‘spring’
  • Excessive soft tissue at the tip of the nose
  • Thicker skin at the tip of the nose

The exact cause of your bulbous nose will determine the best solution, and the specific rhinoplasty technique needed for correction.

How Does Rhinoplasty Correct a Bulbous Nose? 

Patients with a bulbous tip can benefit from rhinoplasty for a narrower nasal tip that has better symmetry with the rest of the face.

A bulbous nose surgery procedure can be performed to create a more attractive and slimmer nasal tip, bringing the nose into better symmetry with the rest of the face. Bulbous nose tip surgery aims to create a natural-looking, narrower point at the tip of the nose. During rhinoplasty, this is done in two stages:

  • Step 1: Minimally remove and reshape the tip cartilages with sutures
  • Step 2: Support the tip cartilages from the bottom with cartilage grafts from the septum, ear or rib
  • Step 3: Add cartilage to the leading edge of the tip to create better definition and push against thicker tip skin
  • Step 4: Create straighter lines of definition from the tip laterally, often using cartilage grafts along the nostril rims (alar rim grafts).

Skin and soft tissue may rarely be thinned in the process if overly thick, but generally this leads to longer postoperative swelling that may turn to scar, defeating the goals of creating a narrower tip. Soft tissue is generally only removed when previous rhinoplasty has created excessive scar, adding to tip bulbosity.

How Effective is Rhinoplasty for Correcting a Bulbous Nose?

Rhinoplasty for a bulbous nose is among the most frequently performed cosmetic surgeries. More than 95% of patients at Westlake Dermatology are pleased with their results.

A consultation with a board-certified plastic surgeon or facial plastic surgeon can help you decide if rhinoplasty is right for you, and which specific techniques are needed to correct your bulbous tip. During the consultation, photo imaging may be performed to ensure that your aesthetic goals can be attained by your surgeon.

How Bulbous Nose Surgery is Performed? 

There are two main types of rhinoplasty surgery, closed and open. In a closed surgery, all incisions are placed within the nostrils. This surgery allows for only minor changes to the structure of the nose.

Open surgery is often recommended for correcting a bulbous tip. This type of surgery allows greater access to the tip of the nose, for more detailed refinement.

During open surgery, incisions are still made within the nostrils, with one additional incision made across the columella of the nose. While open rhinoplasty does leave a scar, this scar becomes virtually invisible as it heals. If needed, lasers can further improve the scar, but this is rarely needed.

  • Closed Surgery: 2 parallel incisions are made on each side within each nostril. This allows the surgeon to draw the tip cartilages out of the nose, work on them, then return them to their new position.
  • Open Surgery: 3 incisions are made, one within each nostril and one hidden beneath the nose across the central columella. This allows the surgeon to elevate the skin off the underlying cartilages, reshape & support them, and then close the incisions over the newly improved cartilages.

Rhinoplasty for a bulbous nose requires general anesthesia and generally takes 2-3 hours to complete.

How Long Does It Take to Recover?

The tip of the nose takes the longest to heal. Recovering from corrective surgery for a bulbous nose takes 2 to 3 weeks. Residual swelling will continue to decline for up to one year or longer after surgery.

Week 1: Rest as much as possible with the head elevated above the heart. Swelling and bruising is at its worst during week 1.

Week 2: Stitches, tape and cast are removed after the first week. Some patients are coached to tape the nose at night to further minimize swelling for an additional variable amount of time. At this point the nose still looks like “Miss Piggy”, since swelling makes the tip look very upturned and the nostrils look huge.

Week 3: The nose starts to turn down as swelling continues to resolve. The upper lip, stiff until now, starts to soften so the upper teeth are not as hidden during smiling. Most people around you will not be able to detect that you have had surgery after the 2nd week. You may begin to exercise and you may fly.

Week 4: Your surgeon may recommend steroid injections into the thicker skin of the tip if swelling is not improving at a rapid enough rate. If swelling persists for too long, it turns to scar and interferes with a good final outcome.

Month 34:  Your swelling will be down about 85% by now. The tip still feels very firm and numb, but the shape is looking better and better.  Day-to-day variations in shape are still occurring due to variable swelling, but these become less and less frequent.

Swelling will continue to decline for one year after surgery, or even longer in patients with thick skin or those who have had previous surgery.

Minas Constantinides, MD, FACS

Dr. Minas Constantinides is a board-certified Facial Plastic Surgeon at Westlake Dermatology & Cosmetic Surgery in Austin, Texas. He is on the Executive Committee of the American Academy of Facial Plastic and Reconstructive Surgery (AAFPRS) and is a Senior Advisor of the American Board of Facial Plastic and Reconstructive Surgery (ABFPRS).

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