Nasal Tip Plasty on the Bulbous Nose Revisited

Shin, Keuk Shun; Kim, Keun Sik; Cho, Pil Dong

Abstract

Correction of bulbous nasal tip in rhinoplasty is a difficult subject, particularly in Asian. Since first published an article on the correction of bulbous nasal tip in 1999, we have accumulated more experiences and improved our result in refining nasal tip. We had 17 patients for the correction of bulbous nasal tip. Age ranged from 20 to 39 years old (Mean age, 26.7 years old) and 6 males and 11 females. We were able to follow up from 1 month to 6 years. We classified our patients into three groups according to the shapes of nasal tip and surgical procedures implicated. Group 1: Simple bulbous nasal tip requiring excision of subdermal soft tissue and rearrangement. Group 2: Bulbous nasal tip with flat dorsum of nose, requiring augmentation of dorsum of nose with silicone implant and augmentation of nasal tip with onlay graft with conchal cartilage. Group 3: Bulbous nasal tip with short columella, requiring nasal tip plasty and lengthening of columella with composite graft using helix of ear. Open rhinoplasty technique was applied in all patients with excising subdermal fibrous tissue from nasal tip, and realignment and fixation of alar cartilage with interdomal sutures. Pressure splint was applied on 7th postoperative days and maintained for a couple of months. Proper preoperative diagnosis, subdermal soft tissue excision, realignment and fixation of alar cartilage, cartilage graft, augmentation of dorsum of nose, columella lengthening, postoperative splint and combinations of these are the key of successful results.