The issue with bulbous noses lies in thick subcutaneous fat and fibrous tissue in the nasal tip, along with hypertrophy of the alar cartilage, excessive angle of the alar cartilage, and posterior retraction. Among Asians, alar cartilage hypertrophy is less common; instead, it's primarily caused by an excessive angle between the two alar cartilages and posterior retraction of the lateral alar cartilage.
Experts explain that bulbous noses fall into two categories: the first involves a low nasal bridge paired with a thick, short nasal tip—the most common type. The second features a nasal tip that isn't low but is large, thick, and short, caused by overly developed nasal tip cartilage. For unattractive bulbous noses, the most direct and thorough solution currently available is bulbous nose correction surgery.
Rhinoplasty Methods for Bulbous Noses
For bulbous nose correction, if excessive cartilage is the issue, the protruding nasal tip cartilage is removed. If subcutaneous fat and fibrous tissue are the primary concern, the procedure becomes more complex, requiring adjustments to both cartilage and muscle. When necessary, the alar base and nasal tip are also addressed. If the angle between the lateral alar cartilages is excessively wide, suturing techniques can be employed to refine it. The final height of the nasal tip must remain within the patient's natural aesthetic range.
Two primary surgical approaches exist for bulbous nose correction:
1. Nasal Tip Soft Tissue Resection: For cases without excessive soft tissue, a columellar transverse incision or "V" incision is made to remove excess soft tissue.
2. Nasal alar cartilage retraction suturing: Using a columellar transverse incision or "V" incision, the bilateral alar cartilages are exposed and sutured inward to elevate the nasal tip.