The bulbous, round tip

‘Whoever knows how to operate on the nasal tip knows how to perform a Rhinoplasty’

This is indeed a common saying among Rhinoplasty Surgeons and reflects the challenge that the correction of the nasal tip can mean.

A thinner, more defined and elegant tip is one of the most commonly requested changes by patients. There are two main factors that contribute to a round, bulbous appearance of the nasal tip. The first is a thick skin which in some cases can be thinned with great caution. The most common one though is the shape and the bulk of the underlying cartilages. This means that the lower lateral cartilages of the nose may be too round, to bulky, to distant to each other or even asymmetric. There are several techniques of correcting these deformities but one should keep in mind that the cartilage is the skeleton of the nose that gives support and protects its function. For this reason it must be treated very carefully by a well-trained specialized Surgeon in order to offer optimum results with minimal risk. In cases of too bulky or rounded lower lateral cartilages, trimming of their upper (cephalic) part is a very efficient technique. Nevertheless, this needs to be done with great caution since aggressive excision can compromise the structural support of the nose.

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How can a nasal tip be refined?

This a short overview of the most important techniques that the Surgeon can use for this purpose.

Cephalic trim

In cases of too bulky or rounded lower lateral cartilages, trimming of their upper (cephalic) part is a very efficient technique. Nevertheless, this needs to be done with great caution since aggressive excision can compromise the structural support of the nose.

Lateral Crural Strut Graft

 This technique is also very efficient in dealing with a bulbous tip. Strut grafts are usually taken from the nasal septum and are sutured underneath the convex lower lateral cartilages. The cartilages are flattened and straightened thus resulting in a thinner, less round nasal tip.

Tip defining sutures

These are sutures that are placed trans and inter-domaly. This means that, depending on the case, they manage to sharpen each dome separately (trans) but also to bring the two domes together (inter). As a result a thinner, unified and more defined tip can be achieved. In addition, these sutures can pull the lower lateral cartilages downward to help flatten them and reduce any bulbosity.

Shield Graft

The so called ‘shield’ graft is, as a principle, harvested from the nasal septum or the ear and is sutured appropriately on the lower lateral cartilages. It is an excellent way of providing more definition as well as slight projection and length to an amorphous tip that is usually covered by thick skin.

Conclusively, refinement of the tip of the nose is a challenging procedure that requires deep knowledge of the anatomy and the mechanics of the nasal skeleton. A thorough assessment and a sincere discussion with the patient before surgery are crucial for a delightful outcome. The techniques that we analyzed, together with numerous others allow an experienced, appropriately trained Surgeon to achieve excellent results in terms of both aesthetics and functionality.

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