eMedicine Specialties > Otolaryngology and Facial Plastic Surgery > Cosmetic Surgery

Rhinoplasty, Broad Nasal Tip

Author: J Charlie Finn, MD, Assistant Consulting Professor of Surgery, Department of Surgery, Duke University
Contributor Information and Disclosures

Updated: Jul 8, 2008

Introduction

History of the Procedure

Refinement of broad nasal tip has been a challenge since the first rhinoplasty was performed. Successful narrowing of the nasal tip requires a thorough understanding of the causes of broad nasal tip and the different tools available to address each cause. Skill in a variety of approaches and procedures is required to properly address the diverse anatomy encountered in treating broad nasal tip.

Problem

Broad nasal tip refers to the appearance resulting from excessively wide tip defining points or from a disproportion in width between the dorsum and the tip. Other important factors to consider in assessment include skin thickness, racial origins and patterns, and cartilage strength.

Frequency

Although prevalence has not been studied, broad nasal tip is a common reason of patients seeking rhinoplasty. Broad nasal tip is the dominant problem in many rhinoplasties, while in others it may be a secondary concern.

Etiology

Multiple anatomic causes for broad nasal tip exist. The bulbous nasal tip appears as a broad rounding of the area of the lateral crura of the lower lateral cartilages. Commonly, the broad nasal tip has strong and broad lower lateral cartilages. A bulbous nasal tip appearance results when lower lateral cartilages have strong bidomal configurations.

Excessive divergence of length of the middle crura can also contribute to a wide, boxy tip appearance. From the basal view, a trapezoidal or rectangular configuration to the tip may occur due to an increased angle of divergence of the middle crura.

A weak cartilaginous structure and thickened nasal tip skin create a broad nasal tip with poor definition in some patients. This is common in patients of Asian or African descent and can be very difficult to correct. At times, a combination of thick skin and strong cartilage may contribute to broad nasal tip.

The triad of thin skin, strong cartilage, and lower lateral cartilage bifidity is important (see Image 1). Special care must be taken to avoid overexcision of lateral crura in patients with a bulbous tip with this anatomic triad; dome-binding sutures should be applied during rhinoplasty. Great care should be taken to achieve a smooth cartilage result. Otherwise, patients with this triad are at special risk for bossa formation.

Each anatomic configuration has different solutions. "Cookie cutter" rhinoplasties do not exist. Instead, the experienced surgeon chooses from a variety of techniques, depending on the patient's individual anatomic characteristics.

More on Rhinoplasty, Broad Nasal Tip

Overview: Rhinoplasty, Broad Nasal Tip
Treatment: Rhinoplasty, Broad Nasal Tip
Multimedia: Rhinoplasty, Broad Nasal Tip
References
[ CLOSE WINDOW ]

References

  1. Goldman IB. The importance of the medial crura in nasal tip reconstruction. Arch Otolaryngol. 1957;65:143.

  2. Simons RL. Management of the lower third of the nose: Vertical dome division. In: Rhinoplasty: A Practical Guide to Functional and Aesthetic Surgery of the Nose. Kugler Publications; 1998:314-9.

  3. Simons RL. Vertical dome division in rhinoplasty. Otolaryngol Clin North Am. Nov 1987;20(4):785-96. [Medline].

  4. Gunter JP, Friedman RM. Lateral crural strut graft: technique and clinical applications in rhinoplasty. Plast Reconstr Surg. Apr 1997;99(4):943-52; discussion 953-5. [Medline].

  5. Adamson PA. Nasal tip surgery in open rhinoplasty. Facial Plast Surg Clin North Am. 1993;1:39-52.

  6. Constantian MB. The two essential elements for planning tip surgery in primary and secondary rhinoplasty: observations based on review of 100 consecutive patients. Plast Reconstr Surg. Nov 2004;114(6):1571-81; discussion 1582-5. [Medline].

  7. Daniel RK. Rhinoplasty: creating an aesthetic tip. A preliminary report. Plast Reconstr Surg. Dec 1987;80(6):775-83. [Medline].

  8. Gruber RP, Friedman GD. Suture algorithm for the broad or bulbous nasal tip. Plast Reconstr Surg. Dec 2002;110(7):1752-64; discussion 1765-8. [Medline].

  9. Johnson CM, Toriumi DM, eds. Open Structure Rhinoplasty. Philadelphia, Pa: WB Saunders Co; 1990.

  10. Kridel RW, Soliemanzadeh P. Tip grafts in revision rhinoplasty. Facial Plast Surg Clin North Am. Nov 2006;14(4):331-41. [Medline].

  11. Leach JL, Athre RS. Four suture tip rhinoplasty: a powerful tool for controlling tip dynamics. Otolaryngol Head Neck Surg. Aug 2006;135(2):227-31. [Medline].

  12. Lee KC, Kwon YS, Park JM, et al. Nasal tip plasty using various techniques in rhinoplasty. Aesthetic Plast Surg. Nov-Dec 2004;28(6):445-55. [Medline].

  13. Lo S, Rowe-Jones J. Suture techniques in nasal tip sculpture: current concepts. J Laryngol Otol. Aug 2007;121(8):e10. [Medline].

  14. McCollough EG, Mangat D. Systematic approach to correction of the nasal tip in rhinoplasty. Arch Otolaryngol. Jan 1981;107(1):12-6. [Medline].

  15. Romo T 3rd, Kwak ES, Sclafani AP. Revision rhinoplasty using porous high-density polyethylene implants to reestablish ethnic identity. Aesthetic Plast Surg. Nov-Dec 2006;30(6):679-84; discussion 685. [Medline].

  16. Sheen JH. Tip graft: a 20-year retrospective. Plast Reconstr Surg. Jan 1993;91(1):48-63. [Medline].

  17. Tebbetts JB. Shaping and positioning the nasal tip without structural disruption: a new, systematic approach. Plast Reconstr Surg. Jul 1994;94(1):61-77. [Medline].

[ CLOSE WINDOW ]

Further Reading

[ CLOSE WINDOW ]

Keywords

rhinoplasty, broad nasal tip, nose job, nasal surgery, bulbous nasal tip, rhinoplasty, narrowing of the nasal tip

[ CLOSE WINDOW ]

Contributor Information and Disclosures

Author

J Charlie Finn, MD, Assistant Consulting Professor of Surgery, Department of Surgery, Duke University
J Charlie Finn, MD is a member of the following medical societies: American Academy of Facial Plastic and Reconstructive Surgery and American Academy of Otolaryngology-Head and Neck Surgery
Disclosure: Nothing to disclose.

Medical Editor

Daniel G Becker, MD, Clinical Associate Professor, Department of Otorhinolaryngology-Head and Neck Surgery, Division of Facial Plastics and Reconstructive Surgery, University of Pennsylvania
Daniel G Becker, MD is a member of the following medical societies: American Academy of Facial Plastic and Reconstructive Surgery, American Academy of Otolaryngology-Head and Neck Surgery, and American College of Surgeons
Disclosure: Nothing to disclose.

Pharmacy Editor

Francisco Talavera, PharmD, PhD, Senior Pharmacy Editor, eMedicine
Disclosure: Nothing to disclose.

Managing Editor

Dean Toriumi, MD, Department of Otolaryngology, Associate Professor, University of Illinois Medical Center
Disclosure: Nothing to disclose.

CME Editor

Christopher L Slack, MD, Otolaryngology-Facial Plastic Surgery, Private Practice, Associated Coastal ENT; Medical Director, Treasure Coast Sleep Disorders
Christopher L Slack, MD is a member of the following medical societies: Alpha Omega Alpha, American Academy of Facial Plastic and Reconstructive Surgery, American Academy of Otolaryngology-Head and Neck Surgery, and American Medical Association
Disclosure: Nothing to disclose.

Chief Editor

Arlen D Meyers, MD, MBA, Professor, Department of Otolaryngology-Head and Neck Surgery, University of Colorado School of Medicine
Arlen D Meyers, MD, MBA is a member of the following medical societies: American Academy of Facial Plastic and Reconstructive Surgery, American Academy of Otolaryngology-Head and Neck Surgery, and American Head and Neck Society
Disclosure: Advanced Headache Intervention Consulting fee Consulting; Covidien Corp Consulting fee Consulting

 
 
HONcode

We subscribe to the
HONcode principles of the
Health On the Net Foundation

All material on this website is protected by copyright, Copyright© 1994- by Medscape.
This website also contains material copyrighted by 3rd parties.

DISCLAIMER: The content of this Website is not influenced by sponsors. The site is designed primarily for use by qualified physicians and other medical professionals. The information contained herein should NOT be used as a substitute for the advice of an appropriately qualified and licensed physician or other health care provider. The information provided here is for educational and informational purposes only. In no way should it be considered as offering medical advice. Please check with a physician if you suspect you are ill.