Nasal Tip plasty on the Bulbous Nasal Tip

ABSTRACT

Management of the bulbous nasal tip with inadequate projection and drooping is challenging aesthetic plastic surgery. The bulbous nasal tip is influenced by several factors; 1) thick, non-elastic oily skin, 2) soft tissue bulkiness due to supratip fibrous fatty tissue, and 3) a wide intercrural angle or increased interdormal distance. Another common factor among caucasians, hypertrophic alar cartilage, is seen less in orientals. These variable factors can be corrected with various surgical maneuvers for proper tip projection and refined alar shape. All these procedures are performed through open rhinoplasty incision. The fibromuscular fatty tissue on the nasal tip is resected with subdermal tangential excision without violating the detmal blood supply. The proximal part of the lateral crus, dome and the part of medial crus which was isolated from the skin and nasal mucosa are replaced and plicated in midline in the role of a new columellar strut and skeletal support. If more skeletal supports are desired, the new columellar is reinforced with a silicone strut and conchal cartilage onlay grafts are applied. And for lengthening of the columella, a V-Y advancement incision on the columellar base with open rhinoplasty is applied. The pressure splint on the upper third of the columella and nasal tip is applied on the 7th postoperative day and maintained for two months. All procedures are focused on the preservation of catilaginous integrity and in providing skeletal support. We performed nasal tip plasty on the bulbous nasal tip and its simple technique and predictability resulted in improved nasal tip projection and contour.