Bulbous: an adjective meaning round and swollen looking. Bulbous nose? You guessed it: a round and swollen looking nose.
Many patients come to see me for consultation about their bulbous nose. Some patients say the tip of their nose lacks definition or support; others say that their nasal tip needs to be more refined or less round. While the language used to explain this type of nose can vary, these descriptions all allude to the structural differences that result in a bulbous nose. Most common in African American, Asian and Hispanic patients, but found in all ethnicities, the right surgeon can successfully correct a bulbous nose.
Surgically correcting or refining a bulbous nose is one of the more challenging nasal procedures that I perform. In my experience, there are two important components to this procedure. First, the nasal tip needs to be de-fatted. One feature that all bulbous noses have in common is the presence of excess fatty fibrous tissue. This extra fatty tissue gives the nose its swollen appearance. In the photo below, you can see the nasal tip before and after I have removed the excess fatty fibrous tissue
"Defatting" of the tip as well as the weak, "flimsy" cartilage.
The tip of the bulbous nose is often weak and flimsy. The second step involves adding support to the nose with cartilage grafts. Taken from the nasal septum or ear, I use cartilage grafts to bolster the nose, much like the frame of a house supports the roof, or tent poles hold up a tent. I typically achieve this using two different types of grafts, the shield graft and the strut graft. The shield graft, named for its shape, is custom-carved out of cartilage and provides much of the framework for the nasal tip. The strut graft contributes additional support and reinforces the structure of the nose.
Patients often wonder how I access the internal parts of the nose. They ask whether bulbous nose correction can be performed as "Closed" Rhinoplasty, where the nose is left relatively intact and the inside of the nose is accessed only through the nostrils. In my opinion, this procedure is best performed as "Open" Rhinoplasty. That is the only real way to address both essential components: the excess of fat in the nasal tip and the lack of cartilage support. In this situation, a closed approach would greatly limit the surgeon's ability to properly reach and correct the source of the patient's concerns. Though it may sound like an unusual or scary technique, Open Rhinoplasty doesn't drastically affect the surgery experience or recuperation for the patient. In this case, it is the best way to achieve the desired result.
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