Why the nasal bridge looks wide and the tip looks bulbous: how osteotomy and autologous rib cartilage correction work

Hello, I am Dr. Peter C. Kang.

Today, I will introduce a rhinoplasty case of a patient who wanted to improve a wide nasal bridge and a bulbous nasal tip.

This was the patient's first rhinoplasty.

When the patient visited our clinic for consultation, the requests were as follows:

• Improvement of bulbous nasal tip

• Rounded rather than overly pointed

• Desired an overall natural nasal shape

In particular, the patient had significant concerns about the bulbous appearance of the nasal tip and preferred a soft, natural tip rather than an overly sharp or pointed look.

Upon checking the patient's septum in the operating room, the septal cartilage was deviated, thin, and small. Accordingly, I planned to minimally correct only the deviated segment and reconstruct the nasal tip using autologous rib cartilage.

1. Septoplasty

• Selective correction of only the deviated portion of the septum

• Maximum preservation of the thin, small septal cartilage

• Performed strictly within a range that does not affect nasal function

2. Nasal tip plasty using autologous rib cartilage

• Harvested autologous rib cartilage due to insufficient septal cartilage

• Stable establishment of tip support

• Refining the bulbous nasal tip into a natural, well-projected shape

• Achieved the soft, rounded contour requested by the patient

3. Lateral osteotomy

• Refined the wide-looking nasal bridge into a sleeker contour

• Narrowed the nasal bone width to create a refined line

• Natural transition between the nasal bridge and tip

4. Custom carving of the silicone implant

• Silicone implant precisely carved to match the patient's nasal bone contours

• Meticulously carved to fit the narrowed nasal bone contour after osteotomy

• Smooth and natural nasal bridge line achieved

5. Nasolabial angle correction

• Adjustment of the angle between the nose and the lips

• Completed a more refined silhouette from the profile view

• Improvement in overall facial balance

1. Frontal changes

• The wide-looking nasal bridge was refined into a sleeker line

• The bulbous nasal tip was naturally contoured

• An overall refined and neat impression

2. Profile changes

• A well-projected yet soft nasal tip line

• A refined profile through nasolabial angle correction

• A natural transition between the nasal bridge and tip

3. Changes in the nasal tip

• Bulbousness was improved, creating a well-defined look

• A natural shape without excessive sharpness

• The soft, rounded nasal tip that the patient desired

In rhinoplasty, the condition of the septal cartilage greatly influences the surgical plan. In this case, because the septal cartilage was deviated, thin, and small, the most suitable approach was determined after direct evaluation in the operating room.

When septal cartilage is insufficient, attempting to build tip projection solely with the septum can result in weak support, causing the nasal tip to droop or collapse over time. In such cases, using autologous rib cartilage to secure adequate structural support is important for stable, long-term results.

Additionally, the wide-looking nasal bridge was narrowed through lateral osteotomy to create a sleeker contour, and a silicone implant was carved precisely to match the nasal bone anatomy, achieving a natural bridge line.

As the patient desired, I was able to create a well-defined, natural nose that is not overly pointed. The most important aspect of rhinoplasty is harmonizing with the patient's face while accurately realizing their aesthetic goals.

I will continue to provide customized surgical care tailored to each patient. I hope this case helps those with similar concerns. This has been Dr. Peter C. Kang, Medical Director. Thank you.

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