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Iatrogenic Bulbous Tip

2.) Iatrogenic Bulbous Tip or Revision Rhinoplasty Bulbous Tip

Iatrogenic literally means, “originating from a physician”. The broader definition is an inadvertent adverse effect or complication resulting from medical treatment. In my description, this type of bulbous nose is one that has arisen from a previous surgical intervention, usually a Primary Rhinoplasty procedure.

In my practice, I regularly see Rhinoplasty Revision candidates whose complaints include, among other things, undefined and rounded nasal tips. In many cases, these patients may have had bulbous noses (Type 1. or Type 2.) prior to their first, failed Rhinoplasty. Unfortunately, rather than properly correcting the issue, the operating surgeon’s attempts to reduce the bulbosity either didn’t work at all or may have even exacerbated the bulbosity. In some cases, the previous surgeon tried to refine the nasal tip with the insertion of excessive alloplastic (non-biologic) material, such as an L-Shaped Silicone Implant, or with Cartilage Grafts. When done incorrectly, the insertion of these materials will actually add fullness to the nasal tip, instead of refining the shape, as intended. In fact, the bulbous tip that results from the addition of inappropriately shaped/sized implant material can be further worsened by poor surgical technique that can create scar tissue within the nasal tip. Iatrogenic or Revision Rhinoplasty bulbous tip implies that a patient has had a previous Rhinoplasty and either developed a bulbous tip or the bulbous tip was never properly treated. In these, Revision Rhinoplasty cases, the tip needs to be opened and the scar tissue removed and replace with adequate cartilage supporting grafts harvested from the septum, ear or rib. In addition, small pieces of Medpor, Silicone or Gore-Tex Grafts may be used.

Patients that have bulbous tips from previous Rhinoplasty can also include an associated Pollybeak Deformity, as I have shown in my published study of Ethnic Rhinoplasty complications.

Case #1

Rhinoplasty Revision for Bulbous Tip and Pollybeak Deformity.

Revision Rhinoplasty for Iatrogenic Bulbous Tip and Pollybeak Deformity.

Revision Rhinoplasty for Iatrogenic Bulbous Tip and Pollybeak Deformity.

Case #2

Scar Tissue from previous Rhinoplasty causing Bulbous Tip.

Revision Rhinoplasty using Strut and Shield Graft with Soft Tissue Graft.

Post-Revision Rhinoplasty Bulbous Tip from scar tissue and poor graft placement.

Case #3

Revision Rhinoplasty for Bulbous Tip and Pollybeak Deformity.

Excision of Scar Tissue causing Bulbous Tip.

Post–Revision Rhinoplasty for Bulbous Tip and Pollybeak Deformity.

Case #4

24 year old Caucasian female who had a Primary Rhinoplasty in Beverly Hills.
She was unhappy with her bulbous, droopy tip. In addition to having thick skin
and fibrofatty tissue in the tip, there was scar tissue under the tip skin.
The previous surgeon created the scar tissue by operating in the wrong
surgical plane. In addition, the previous surgeon, removed too much cartilage
in the cephalic portion of the upper lateral cartilages, destabilizing the
tip and contributing to the bulbous and droopy nature of the tip
and Pollybeak Deformity.

Dr. Slupchynskyj performed a Revision Rhinoplasty,
removing the scar and fibrofatty tissue from the tip.
Dr. Slupchynskyj also reconstructed the tip with Septal Cartilage
Strut and Shield Grafts, reinforcing the tip and reducing the
bulbous and droopy appearance. The patient is 3 months
post-op and is thrilled with the results.

Revision Rhinoplasty using Septal Strut and Shield Grafts.

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