A bulbous nose, commonly known as a "garlic nose," encompasses two deformities: an enlarged nasal tip and overly wide/thick alar cartilages. Because a "garlic nose" can make a person appear clumsy and dull, individuals with this condition often opt for nasal tip reduction surgery to improve their appearance. Nasal tip reduction can be tailored to different surgical approaches based on the specific characteristics of the patient's nasal tip deformity.
Nasal tip reduction surgery involves diminishing the overall size of the nose and reducing the components that constitute it, such as the nasal bone and cartilage. To reduce the nose's size, these structures are shaved down to lower their height. To decrease the size of the cartilage portion, a segment of cartilage may be excised or its structure modified.
Nasal tip reduction generally involves a more complex surgical process than rhinoplasty. Typically, a butterfly incision is made along the alar margin. The skin is then dissected to expose the alar cartilage. A portion of the alar cartilage is excised at the dome area, reshaped, and sutured. Excess subcutaneous connective tissue, fat, and nasal skin are subsequently removed before final closure.The procedure takes approximately one hour and is usually performed under local anesthesia. Patients should discuss specific details thoroughly with their surgeon prior to surgery.
Surgical Approaches for Nasal Tip Reduction
1. Cartilage Grafting Technique: An incision is made along the nasal margin inside the nostril or within the nasal vestibule to expose the alar cartilage and lateral nasal cartilage. Depending on the case, the cephalic portion of the alar cartilage or the caudal portion of the lateral nasal cartilage is excised.The excised cartilage is reshaped and sutured to the apex of the nasal dome to elevate the nasal tip. Alternatively, conchal cartilage from the ear can be harvested for grafting.
2. Bilateral Nasal Alar Cartilage Medial Foot Adduction Rhinoplasty: Incisions are made on the lateral sides of both columellae to expose the medial feet of the alar cartilages and the nasal dome. Soft tissue between the two medial feet is excised, followed by mattress sutures near their upper and lower ends to bring the medial feet closer together.This technique elevates the nasal tip by 2-3mm.
3. Wedge Resection of Nasal Wing Base for Nasal Tip Reduction: When the nasal tip shape is generally good but slightly low, a wedge-shaped full-thickness tissue segment is excised from both nasal wing bases. This narrows the nostrils and elevates the dome area, thereby raising the nasal tip.Editor's Note: A bulbous nose detracts from aesthetics and may create an initial impression of dullness or clumsiness. If feasible, nasal tip reduction surgery can be considered for improvement.