I am a 45 year old professional woman. I would describe my nose as bulbous and it takes over my entire face. I would like to have a nose job, but have some concerns. If my nose is greatly narrowed and the tip completely reshaped, wouldn’t that result in a lot of scar tissue that is visible? When changing the size and shape of a nose so drastically, does that involve going into the bone?
Your questions are good ones and your nose is the shape that I have a great deal of experience with in performing rhinoplasty. The most important discussion regarding rhinoplasty in an individual with a large bulbous tip who desires cosmetic changes to the nasal tip, is the pre operative conversation. It is extremely important to set realistic expectations with the individuals who present with the type of nose that you have described. I use computer imaging in my rhinoplasty consultations and in patients such as yourself, I am very careful as to how narrow or how well defined I make the nasal tip as your particular nasal structure will likely prevent me from making your tip very narrow because of the reasons that you have outlined yourself. A wide bulbous tip usually has thick skin with a great deal of subcutaneous fat. Even with cartilage reshaping and defatting of the nasal tip, there is going to be scar tissue that forms which prevents the tip from narrowing further. The good news is that this scar tissue of the nasal tip is completely invisible beneath the skin, and injections of steroid into the nasal tip can decrease the amount of scar tissue that forms giving you a very satisfactory post rhinoplasty appearance. Changing the shape of the nasal tip rarely involves changes to the bony portion of the nose.
Posted by Dr. Philip Schoenfeld