May 27

Narrowing a bulbous tip

A bulbous nasal tip is one of the most common reasons for patients to seek rhinoplasty. A bulbous tip, often called a boxy tip, refers to a tip that is too wide and prominent in proportion to the rest of the nose and other facial features. The key focus in our approach to bulbous tips is in emphasizing creation of a sense of tip refinement and definition rather than excessive narrowing.

To accomplish this, we rely heavily on suture techniques that draw the tip cartilages into exactly the shape we want rather than relying too much on older techniques that involve removal of strips of cartilage from the tip in order to make it smaller. The advantage of our approach is an extraordinary degree of reliability and predictability that can do away with potential problems like pinching of the tip, loss of tip support, and breathing issues.

One other consideration in evaluating bulbous tips is the need to address any other contributing factors. Many bulbous tips are not just wide — they are too prominent in all dimensions including being overprojected, or pointing out too far away from the face. Often, and especially in ethnic patients, the fatty tissue overlying the tip cartilage is also thick and needs to be dealt with if we hope to get the best possible result. The open technique is by far the superior approach for dealing with both of these issues because the cartilage and fatty tissue can be addressed directly as opposed to using indirect methods to deproject the tip that potentially weaken tip support. This allows us to create a tip that is symmetrical, smooth, and strong enough to hold up for a lifetime.

The patient below is shown before and 1 year after open rhinoplasty for refinement of a bulbous tip. Note how the boxy appearance has been transformed into a more triangular contour while remaining smooth and without looking pinched.

Bulbous tip base

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14 Comments so far

  1. kika June 2nd, 2010 4:02 am

    thats a fine work you did, is it possible to make a mixed race girl bolbous tip to look that way? I have been trying to get the best rhinoplasty surgeon to make my tip more pointy and build up my bridge but with no luck, i dont like the photos i see on their gallery, i have the money now for my procedure but i dont want to waste money on something that will need revision in the future. its really difficult to know the right surgeon to choose.


  2. admin June 2nd, 2010 8:23 am

    Hi Kika,

    Thanks for your comment. It is absolutely possible to obtain similar tip refinement for people of other ethnicities. How defined you can get depends a lot on the thickness of your skin and other factors. We prefer to use your own cartilage to build up and augment your nose to create the desired shape in a natural way.

    The approach to ethnic rhinoplasty is completely different than the techniques used for the average Caucasian nose. So, we urge you to see a rhinoplasty specialist with experience in ethnic noses. We’d be happy to see you in consultation either in person or via skype if you live far away. All the best.

  3. kika June 2nd, 2010 10:03 am

    thanks for the reply, i live very far but will travel to have my rhinoplasty, i will like to have consultation with you guys via skpe asap.


  4. Brenda August 8th, 2010 2:32 pm

    Hi, I’ve looking for a doctor for my rhinoplasty for more tha a year. All I need is a tip refinement; I don’t have any other kind of problem. Your techniques sound very convicing and your pictures show very natural results. My biggest fears are that my nose become over projected or my nostrils get large as I have seen that problem in other websites’ “after” pictures. What do you do to better guarantee your patients’ satisfaction?

  5. admin August 9th, 2010 8:01 am

    Hi Brenda,

    Thanks for writing. It is not necessary to change projection or nostril shape in order to provide some narrowing and tip refinement. The desired aesthetic will influence the choice of techniques we use to arrive at your goals. Regardless, all of our techniques provide a stable and predictable change. We do not want to rely on the forces of healing to provide for your result. We want to limit the unpredictability factor to an absolute minimum.

    One of the biggest fears faced by patients is that their result will not turn out as they had hoped or expected. For us, the critical part of the process is the consultation itself and especially the computer imaging. Your aesthetic drives the discussion. We do not image a perfect nose but, rather, a change that is very real and attainable. And, we won’t enter the operating room until we have a very clear sense of what it will take to make you happy with your nose. Then, we won’t leave the OR until we have done everything possible to achieve that or better. While no one can provide an absolute guarantee, we have found that diligent adherence to this principle has done much to maximize our patients’ happiness.

  6. Brenda August 14th, 2010 7:31 am

    Your approach sounds wonderful! You really care about your patients’ self-esteem. I love that you do the computer imaging. Can’t wait to have my first consultation with you guys!! Thanks.

  7. ahmed November 29th, 2010 12:47 pm

    Hello Doctor, I had my primary rhinoplasty about 16 years ago and it was a disaster the dr shortened my nose and destroyed my tip. 2 years later I had another revision surgery, there was an improvement but still my columella droops. It appears that my columella is longer than my tip. I would like to change that around, and lower the angle that is formed by the tip of the nose and the upper lip. I dont want a scooped up nose. Can you do that? and will the procedure that you perform last a life time? I am in New Jersey but willing to travel to Cali to have this procedure done.

  8. admin December 5th, 2010 9:50 am

    Hi Ahmed,

    It sounds like your tip is still shortened relative to your columella and is creating an angle that is unsatisfactory for you. Lengthening the tip can absolutely be accomplished but how much length you can get depends on how scarred and contracted your skin has become. It would be best for you to forward some photos to our main site and we can have a better conversation.

    We look forward to helping you.

  9. Ziya April 22nd, 2011 2:56 pm

    This is the third month after my primary rhinoplasty,
    Iam not satisfied with my length of the nose.
    I want increase the length of my nose, its possible?
    I didnt get any link for photo attathment in your comment sending option. If you want to see my current photos i can send.

  10. admin April 25th, 2011 9:16 am

    Hi Ziya,

    Thank you for contacting us. Depending on what was done, your tip may continue to settle down with time. You should review this with your surgeon to discuss what may happen to your tip and nasal length. If you continue to be unhappy, feel free to send photos and we can take a look and let you know our thoughts.

  11. Elaine May 29th, 2011 5:29 am

    Hi Dr,
    I had a nose operation carried out four years ago to reduce a minor dorsal hump. I was very disappointed to see that after the operation the tip of my nose became larger and more bulbous than before the operation(which I do not understand seeing as I only had the hump reduced). I would therefore like to have another operation to refine the tip. My question is therefore: are the chances of it being a successful operation lower considering I have already had a previous nose operation?

  12. admin May 31st, 2011 9:35 am

    Hi Elaine,

    Thank you for contacting us. If you see an experienced revision rhinoplasty surgeon, your chances for a successful operation should be extremely high. Feel free to send us some photos from the Contact Us page on our main site and we can better comment on your situation.

  13. John August 9th, 2011 10:30 pm

    Hi Doctors,

    Is there any other method to fix a bulbous tip other than cartilage grafting? I am very weary of cartilage grafting especially grafting involving the ribs.

  14. admin August 10th, 2011 7:59 am

    Hello John,

    It is not necessary to use cartilage grafting to fix a bulbous tip. Many surgeons today have moved towards using rib cartilage as a preferred graft material, however, we find that it is generally uncalled for in a primary rhinoplasty unless very substantial grafting of the nasal bridge is required. A bulbous tip can most always be treated with the techniques mentioned above.

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