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How to Correct bulbous nose tip (Fatty Nose Tip Correction)

JW Plastic Surgery Center's Rhinoplasty Specialist Dr. Man Koon Suh were invited to the "APS 2018 (Aesthetic Plastic Surgery 2018) / KSAPS / KAPS / ISAPS Joint Meeting" to give a lecture about "Creation of Dorsum-Lobule-ala aesthetics in Bulbous tip in Asians" (How to correct bulbous tip *fatty nose tip* in Asians).

1. Definition of Bulbous Nose Tip and Types of Bulbous Nose Tip:

Bulbous tip is defined as large nasal tip regardless of the underlying etiology.
For Asian rhinoplasty surgeons, bulbous tip correction is a common yet challenging procedure, with frequent disappointments.

The causes of bulbous nose are: excessively developed cartilage of the nasal tip; abnormal spread of the cartilage to both sides of the nose; excessive flesh between the nose tip and alar. Considering individuals’ face and needs, we create a sharp and slim nasal tip for you by revising cartilage and/or removing fat layers under the alar skin.
JW does not only reduce the size of the nasal tip but also corrects bulbous tip through reshaping of the nasal tip and refining thick skin tissues.

The ideal nasal tip shape in Caucasians is described as having domal arch of 4 mm, 30 degrees of domal divergence angle.
However, these standards cannot be applied to Asians because the skin and soft tissue of the nasal tip is much thicker with smaller lower lateral cartilages.

There are Two types of bulbous nose tip.

1) Wide nose tip and big nose.
2) Nose itself is not big but for some reason nose tip looks wide or boxy.

2. What is difference between Regular bulbous Nose Tip Correction VS JW Plastic Surgery Center's Bulbous Nose Tip Correction.

1) Other Plastic Surgery Center: They mainly focus on reducing volume of your nose tip from other Plastic Surgery Center, which it can cause pinched looking appearance nose tip.

2) JW Plastic Surgery Center's bulbous nose tip correction: For the bulbous nose tip correction is not just about the reducing volume of your nose tip. JW think about the angle, sizes, height, not upturned, and have little bit of volume after the surgery. 

Surgery Method to Correct Bulbous Nose Tip:

1. Transdomal Suture: 

To decrease the volume of tip, lower lateral cartilage manipulation is first considered.
Transdomal suture decreases the domal definition angle and lateral crural convexity.

This is the example of Bulbous Nose Tip Correction; Cartilage predominant Type

 Before (front)
 After (front)
 Before (bottom)
2 months After (bottom)

This is the example of Bulbous Nose Tip Correction; Soft tissue predominant Type
(Soft tissue predominant type needs a soft tissue debulkingBecause the thick skin is not elastic and does not shrink wrap onto the cartilage framework, adequate tip projection with firm rigid structural graft is necessary to fully expand the skin envelope.)
 Septal Extension Graft

Columella Strut Graft

Is the bulbous tip correction simply a volume reduction?

An aesthetically pleasing nasal tip is not determined only by volume of the tip.
Some patients say my nose is bulbous, even though their tip is pinched. 
And Many patients will say "me too” when the nose actually is small. This most commonly happens because of lack of shadow.

If a bulbous tip in an Asian patient is managed purely in terms of volume reduction, the resulting nasal tip can appear pinched.

Achieve voluminous shadow/highlight, and fineness of dorsum-tip-ala aesthetic line

Toriumi described ideal tip by the concept of highlights and shadows. According to him, attractive tips are not always narrower, but have favorable highlight and shadowing. On the frontal view, supratip area should be narrower and have shadow that continues into the supra-alar regions. The transition from the tip lobule to the alar lobule is smooth, without any pinching. 

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