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Ethnic Bulbous Tip Anatomy

3.) Ethnic Bulbous Tip

“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 seem 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.

Some ethnicities are prone to nasal features that contribute to the bulbous appearance of the tip; however, I have seen Caucasian patients with the same bulbous tip issues. African-American, Asian, Hispanic and Middle Eastern patients are some of the ethnicities in this group. These patients can sometimes have thicker, more sebaceous nasal skin. The sebaceous glands are microscopic glands in the skin that secrete an oily/waxy matter, called sebum, to lubricate and waterproof the skin. An increased occurrence of these glands can add to skin thickness and the appearance of bulbosity; however, even patients that do not have sebaceous skin can still have increased skin thickness—simply due to thicker epidermal and dermal layers. As we travel deeper below the surface of the skin, some individuals may have excessive subcutaneous tissue or fat. This excess fatty (fibrofatty tissue) layer also contributes to the rounded or swollen appearance. Another characteristic of the Ethnic bulbous nose is the weakness of the Lower Lateral Cartilage structures. The diagram above shows how the Lower Lateral Cartilages define and support the nasal tip. In some ethnic patients, these same structures are thin, soft and less supportive, leading to an amorphous, bulbous nasal tip.

Take a look at the figure below; it clearly illustrates two of the previously mentioned anatomical differences that can contribute to the Ethnic bulbous nose. Note the smaller, less prominent Lower Lateral Cartilages in the Ethnic patient to the right, in addition to the thicker layer of fat in the nasal tip. These factors, in combination with thicker and sometimes sebaceous skin create the Ethnic bulbous nasal tip. Once fibrofatty tissue is removed and skin thinned out, supportive Cartilage Tip, Shield and Strut Grafts are fashioned from the septal cartilage that will provide the nose with a more defined, less bulbous appearance. Surgical photos and diagrams show this below.

Comparison of Caucasian Nasal Anatomy vs. a Thick Ethnic Nose.

Defatting of the Nasal Tip Fibrofatty Tissue.

Defatting the Tip: fibrofatty tissue removed from the Bulbous Tip.

Fibrofatty Tissue Contributing to a Bulbous Tip.

Fibrofatty tissue removed from the Tip and Shield and Strut Grafts sutured in place.

Ethnic Bulbous Tip Rhinoplasty

Ethnic Bulbous Tip Rhinoplasty

Ethnic Bulbous Tip Rhinoplasty

Ethnic Bulbous Tip Rhinoplasty

Ethnic Bulbous Tip Rhinoplasty

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