Date: December 4, 2004
Conference: Korean Society of Aesthetic Plastic Surgery (2004 Symposium – Invited Speaker)
Venue: Main Auditorium, Asan Medical Center
Title: Tip-plasty of the Bulbous Nose
Presenter: Dr. Myung Ju Lee, VIP Plastic Surgery Clinic

Overview

A “bulbous nose” generally refers to a nasal tip that appears broad or rounded, often extending to the entirety of the tip region. The cause is closely related to the thickness of the nasal tip skin, the size and width of the lateral crura, and the angulation of the nasal tip cartilages. Prior to surgery, it is essential to assess each individual’s anatomical characteristics because variations in skin thickness and cartilage shape require different surgical approaches.

Surgical Techniques and Considerations

1. Cartilage Reshaping

   • Cephalic Trimming, Transdomal Sutures, and Interdomal Sutures are used to reduce the size and refine the shape of the nasal tip cartilages. When resecting the cephalic portion of the lateral crus, 5–8 mm of the cartilage width is typically preserved, depending on cartilage strength and skin thickness. Over-resection can lead to complications such as a pinched tip deformity, rim notching, or weakened external nasal valves.

2. Transdomal Sutures

   • Used to decrease an excessive domal (tip-defining) angle. If too much tension is applied, the lateral crus can become overly concave, so care must be taken to prevent overcorrection.

3. Interdomal Sutures

   • Employed to reduce the divergence angle between the domes (normally around 60°). Suturing is placed closer to the cephalic portion while maintaining the appropriate anterior divergence angle.

4. Augmentation and Tip Grafts

   • After establishing a stable base via cartilage reshaping and suture techniques, a tip graft can be placed for further contour refinement. This is especially important in creating a more defined tip in cases with weaker cartilage or thicker skin.

5. Thick Skin Management

   • In patients with very thick nasal tip skin, partial internal thinning may be necessary. Reinforcing the underlying cartilage structure is also crucial for adequate tip definition. Additionally, for more prominent edema or to help define the supratip area, low-dose, highly diluted triamcinolone injections (diluted by 4–10 times, in amounts of 0.05–0.1 cc) may be administered starting about one week postoperatively, at two- to three-week intervals for a total of two or three sessions.

Conclusion

Bulbous nose correction requires careful preoperative analysis to determine the most suitable surgical method. Techniques such as cephalic trimming, transdomal and interdomal sutures, as well as judicious use of tip grafts, can effectively refine and narrow a broad, rounded nasal tip. In patients with thick skin, internal thinning and postoperative triamcinolone injections may be added to enhance definition. Through this multi-faceted approach, a more balanced and aesthetically pleasing nasal tip can be achieved.