Large or Bulbous Tip
A more refined, elegant nasal tip is a common request for rhinoplasty. There are a few common factors that can create tip bulbosity.
The shape of the nasal tip is made by the cartilage in the lower third of the nose. The cause of an enlarged or bulbous tip may be a result of enlarged cartilages, wide or convex shape or asymmetry. In addition, the thickness of the patient’s skin can also determine the width of the nasal tip.
Patients with ethnic skin tend to have thicker skin that enlarges the size of the nasal tip.
Dr De Silva creates a more refined nasal tip by shaping and sculpting the lower lateral cartilages that are often too wide and asymmetrical. The use of special stitches (termed dome binding sutures) will also help shape the tip further by creating additional definition.
These dome binding sutures can be used to reshape and refine the nasal tip. In patients with thicker skin, additional principles may also be required including thinning the skin at the nasal tip and placing a cartilage graft underneath the cartilages called a lower lateral crural strut graft.
The shaping of the Lower lateral cartilages. The key with refinement is to avoid over reduction of the lower lateral cartilages as this can sufficiently reduce the structure of the nose resulting in a pinched nasal tip or collapse on breathing.
Dr De Silva takes care to measure the cartilages to ensure there is sufficient structural support of the tip to last for years to come.