The bulbous or rounded nasal tip is a common reason that patients request to have rhinoplasty surgery. A bulbous nasal tip is more rounded with a ball like appearance at the end of the nose. Individuals typically comment that their nose looks to big or wide. Others describe the nose as having no shape. The nasal tip should never draw attention to it. It should be proportional in terms of size and width such that the bridge gently blends or transitions into the nasal tip. Overall, the tip should be triangular shaped without sharp angles with the tip gradually sloping in a convex orientation from the midline out to the sides.
What Causes a Bulbous Tip?
A bulbous, round nasal tip is a direct result of the shape of the lower lateral cartilages. These are a pair of cartilage structures which merge in the midline to help form the support for the nasal tip. They then separate from one another to form the structural support of the nostril on each side. The point at which the cartilages veer away from one another is called the dome region and greatly impacts the overall shape of the nasal tip. A bulbous nasal tip occurs when the domal cartilage is excessively wide and rounded.
What Characterizes a Bulbous Tip?
So what does a bulbous, rounded nasal tip look like in the typical rhinoplasty patient? The photo below is a good example of a bulbous, rounded nasal tip. If you look below at the before frontal view on the left, one of the first things you notice about her nose is the nasal tip region. It is rounded and has no real shape to it. Look at the improved appearance in the after photo located on the right.
Surgical Correction of a Bulbous Tip
Rhinoplasty to correct a bulbous nasal tip is targeted at reshaping the lower lateral cartilage to achieve more of a refined and streamlined appearance.
In some cases this is accomplished by using suture techniques. Sutures can be placed to narrow the domal segments of the lower lateral cartilage. The domal cartilages are brought closer together at the same time. These dome-binding sutures can be very effective at narrowing the tip and providing significant improvement.
Another technique for improving a bulbous tip is called a cephalic trim maneuver. The cephalic portion of the lower lateral cartilage refers to the upper edge of the cartilage (the side opposite the nostril rim) when looking directly at the nose from the frontal view. If this portion of the lower lateral cartilage is excessively prominent, it can contribute to a wider, more bulbous looking nose. If this is the case, then a patient may benefit from a cephalic trim maneuver during the nasal reshaping process.
This involves trimming, or removal, of the prominent cartilage along the cephalic edge. By doing this, the lower lateral cartilage becomes less bulbous and the nasal tip becomes more defined. A cephalic trim maneuver requires great skill to ensure proper symmetry. If performed by an unqualified surgeon, there is risk of removing too much cartilage. The nasal tip must maintain adequate structural support. If too much cartilage is removed during a cephalic trim, there is risk of the nasal tip collapsing. This error results in a pinched nose. When performed properly, a cephalic trimming can result in marked improvement in the shape while maintaining structural support.
Another method for addressing a bulbous nasal tip, involves cartilage grafting of the nose. Grafting means a person’s own cartilage is taken from one area and placed in another for added support or reshaping of the nose. Tip grafts can be placed in various locations to achieve improvements in tip definition, projection, rotation, a structural support. An experienced rhinoplasty surgeon will have a vast knowledge of the various types of tip grafts used to correct a bulbous tip, and will be able to decide which grafts are appropriate to provide tip refinement.