I recently discussed a few ways to improve the bulbous nose and then featured a case study looking at the lateral crural overlay technique to fix tip bulbosity. In today's post I'd like to show you another way of refining a bulbous nasal tip.
Reorient Rather Than Resect
Intuitively, you would think that to make a nose less bulbous one would need to remove a lot of tissue. This was a favored method in the past, but it turns out that resecting nasal tip cartilage with the hope of improving tip bulbosity often results in destabilization, pinching and an unnatural appearance. Like I'd mentioned in my overview of tip bulbosity often what we need to do to improve tip fullness is to reorient the convex lower lateral crura that contribute to this appearance.
The Lower Lateral Crural Strut Graft
One of my favored ways of creating a natural, refined tip is to place a lower lateral crural strut graft. The patient below came to me looking to improve her tip bulbosity.
I performed a very conservative trim (cephalic trim) of the cartilage which then allowed access to the undersurface of the cartilage where a straight piece of cartilage (septal cartilage is typically used) was sewn into place. This cartilage graft is quite stiff and acts like an I-beam once sutured to the original tip cartilage causing the lower lateral crura to flatten.
This is a photo of the patient's convex lower lateral nasal tip cartilages before lower lateral crural strut graft placement.
Next, you can appreciate the flattening of the cartilages that occurred once the cartilage grafts were sutured into place.
A year after surgery the patient has significant improvement to the contour. An added benefit of this technique is that rather than making the tip structure weaker, the strut grafts actually improve the support of the nasal tip sidewall. In fact they're a great alternative to placing alar batten grafts to treat external valve collapse.
So there you have it. Another technique we have in our arsenal to treat bulbous tips. Check back soon to read about specific tip narrowing techniques.
Related Seattle Rhinoplasty Blog posts:
- Bulbous nasal tip case study
- How to improve a wide, bulbous nose
- Nose job I-beams: lower lateral crural strut grafts
- How to fix a bulbous tip
- The crooked and bulbous nose
