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Cartilaginous Bulbous Nasal Tip

The Cartilaginous Bulbous Tip is most common in non-ethnic or Caucasian noses though it can occur in noses of many different backgrounds. This type of bulbous tip is excess natural cartilage in the nasal tip. Dr. Slupchynskyj developed a Three-tiered Surgical Rhinoplasty technique that addresses this round, undefined tip resulting in restored definition, adequate tip structure and support for a more aesthetically pleasing nose.

Tier One Bulbous Tip Correction Technique: Cephalic Strip

The below left photo depicts the lower lateral cartilages which were exposed through the advanced Open Rhinoplasty approach. Convexity of the lower lateral cartilages is evident which contributes to a cartilaginous bulbous tip. To address this type of bulbosity, Dr. Slupchynskyj first performs a Cephalic Strip, which is the removal of a portion of the upper lateral cartilages on the inside, as illustrated in the below right photo.

Tier Two Bulbous Tip Correction Technique: Dome Division

After the Cephalic Strip procedure is completed, a “Dome Division” is performed of the lower lateral cartilages where the medial crura and lateral crura meet at the tip – an area called the “dome”. The goal is to remove the dome’s convexity. An incision is made so the convexity is changed and bulbous nature of the tip reduced. The two ends of the medial crura and lateral Cephalic Strip are then sutured.

Tier Three Bulbous Tip Correction Technique: Cartilage Grafts for Tip Definition and Support

After Dr. Slupchynskyj has removed the Cephalic Strip and performed the Dome Division procedure, he is ready to place the necessary support cartilage grafts. The below right photo illustrates a Septal Strut Graft (harvested from the nasal septum) that is placed between the medial crura of the lower lateral cartilages. This Septal Strut Graft is critical to provide proper tip support achieving shape, definition and integrity of the nasal tip for resolution of the bulbous tip.

Once the Septal Strut Graft is sutured and placed, the medial crura are brought into the septal strut graft and are all depicted as one unit. The photo on the below right shows a carved Cartilage Shield Graft. This graft is harvested from the nasal septum and appears much like a shield. This graft is sutured and placed in a central location to add shape, projection to the nasal tip giving it a less bulbous appearance.

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