Thursday, April 9, 2020

Removing a Bulbous Tip - Rhinoplasty

Hi, Dr. William Portuese here in Seattle. And today we're gonna talk about reduction of the bulbous nasal tip. The bulbous nasal tip can be caused from a variety of issues. It can be caused from thick skin which we really can't do much about because rhinoplasty involves cartilage surgery, not skin surgery. So, if you have really thick skin, [You're] probably not a candidate for a bulbous-tip rhinoplasty. However, if the the bulbous nasal tip is caused by thick and wide and divergent cartilages in the tip of the nose, we can refine those tip cartilages with a combination of suture techniques. And these sutures last about four to six months, holding the cartilages together to narrow and refine the tip cartilages. And then we also perform a conservative cartilage removal so that the width and the bulk of the tip is reduced. The suture techniques that we use to reduce the bulbous tip are really a powerful tool that allows us to give a natural appearance. It's still the patient's own cartilages; just, it's sutured together to give a more narrowed and refined appearance. But the sutures are what's important to hold those cartilages in those newer positions that are more narrower and refined and less bulbous. The bulbous nasal tip involves suture techniques and conservative cartilage removal, and usually osteotomies and sometimes spreader grafts placed in the nose. So it's a lot of work. Therefore, the nose is swollen for a considerable period of time. And especially so because we did so much work on the tip itself. So the tip itself stays swollen for the longest period of time, approximately 70% of the swelling is gone at a month after the surgery, about 90% is gone about three months after the surgery, but full healing takes a year. And some patients who have thick skin in the tip of the nose, will require some steroid shots to ensure that the soft tissue envelope over the framework of the nose heals in a fashion such that it's balanced. Because when you do these techniques in patients with thick skin, there will be an extended amount of swelling left on the inside of the nose. After the bulbous tip reduction surgery with those suture techniques, it doesn't look like I did anything to the nose tip for at least a couple of weeks because it's too swollen, because all the work we had to do to reduce that bulbous nasal tip. So, the swelling is such that it doesn't look like I did much. But you start to see what that nose looks like at about a month, and patients really start to see what it looks like at about three months. The bulbous nasal tip surgery will make the tip of the nose significantly narrower, which will balance with the remainder of the nose depending upon if there's a dorsal hump or a wide bridge. But all we're trying to do is, when patients have a really bulbous nasal tip, it's usually the first thing that everybody sees. And we're trying to just make sure that that bulbous tip is refined such that it blends in with the patient's facial features. After the bulbous tip reduction, the nose does look smaller after the surgery. So this patient presented to us with complaints of a very large, wide, boxy, and bulbous nasal tip. In addition, if you notice right above her boxy tip, she was really pinched in the mid portion of her nose, and then she had wide nasal bones. So what we did was, through a closed-rhinoplasty approach, went in and did a conservative cartilage removal in that nasal tip. And then placed some sutures between the two nasal tip cartilages to reduce the 'bulbousness', to give a significant amount of refinement to that nasal tip. And so I also put... Just above that bulbous tip, I also put a little patient's own cartilage called a spreader graft in that area, which transitions the bridge to the tip, and actually builds out that pinched area right above the tip itself, which also helps reduce the amount of look of the bulbous nasal tip itself. She also underwent a hump reduction and placement of osteotomies which are cuts in the nasal bones to narrow the bridge line, so that the nose looks good in all three dimensions, you know side, three-quarter, and front. But she was very very pleased with the outcome of her results. You know we'd performed a closed rhinoplasty approach that gave her a much better aesthetic profile, and a better balanced tip for her facial features.



Dr William Portuese

1101 Madison St #1280
Seattle, WA, 98104 USA
206-624-6200
https://www.seattlefacial.com

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