Why the nasal tip looks bulbous and spread out, and how septal extension is performed

Hello, I am Dr. Peter C. Kang.

Today, I would like to share the case of a patient who visited our clinic seeking correction for a bulbous, spread-out nasal tip.

This was a primary rhinoplasty case, as the patient had never undergone any prior nasal surgery or procedure. The patient had a congenitally bulbous, spread-out tip shape, and the primary concern was that the nose looked bulky overall. In addition, nasal obstruction caused by a deviated septum was present.

The patient's specific requests were as follows:

• Natural yet defined nasal line

• A naturally elevated tip rather than a sharp, pointy one

• Correction of a bulbous, spread-out nasal tip

• Improvement in nasal obstruction symptoms

The patient specifically preferred a refined yet natural appearance rather than a sharp, overly projected tip. The surgical plan was designed to create a defined yet non-artificial nasal contour that harmonizes naturally with the face.

1. Septal extension using autologous rib cartilage

• Septal extension to correct the bulbous, spread-out nasal tip

• Reinforcing tip support to create an elevated, natural nasal tip

• Achieving a soft tip contour that is not sharp

2. Nasolabial angle correction

• Appropriate adjustment of the nasolabial angle between the nasal tip and the upper lip

• Creation of a natural columellar line

• Completing a refined profile view

3. Nasal bridge augmentation using a silicone implant

• Precisely carving a silicone implant to fit the nasal bone closely

• Placing it strictly over the nasal dorsum to add natural height

• Setting a bridge line that transitions smoothly into the nasal tip

4. Corrective surgery for deviated septum and rhinitis

• Straightening the deviated septum through septoplasty

• Alleviating rhinitis symptoms through inferior turbinate reduction

• Breathing function normalized through relief of nasal obstruction

Front view changes

• The previously bulbous nasal tip has become naturally slimmer

• The spread-out tip is gathered into a refined shape

• An overall well-balanced nasal contour

Profile view changes

• A naturally elevated, well-projected tip achieved through septal extension

• A refined columellar line formed by correcting the nasolabial angle

• A smooth line seamlessly connecting the nasal bridge and tip

Changes on the oblique view

• A natural yet defined nasal contour, even from a 45-degree angle

• An elevated nasal tip line without sharpness

• A refined shape in harmony with the entire face

Changes in nostril shape

• Improved nostril shape as the spread-out nasal tip is gathered

• Balanced, symmetric nostril shape

• Overall neat and refined nasal base line

A bulbous, spread-out nasal tip is a common anatomical feature among Asian patients. When correcting this type of tip, the most critical factor is securing structural support while shaping a natural contour.

In this surgery, the tip support structure was reinforced through septal extension using autologous rib cartilage. Septal extension is one of the most effective techniques to reliably elevate and support the nasal tip, and using autologous rib cartilage provided sufficient structural strength and stability.

Because the patient did not want a sharp nasal tip, special attention was given to finely adjusting the tip height and angle to create a soft, natural contour. By concurrently correcting the nasolabial angle, a natural columellar line transitioning from the nasal tip to the upper lip was established, completing a defined yet non-artificial nasal profile.

On the nasal bridge, a silicone implant was carved with precision to match the patient's nasal bone and placed strictly along the dorsum. Placing the implant solely on the dorsum creates a seamless connection with the nasal tip while preventing the implant from extending into the tip, preserving a more natural feel and shape.

Surgery for the deviated septum and rhinitis was performed at the same time, resolving the nasal obstruction in a single procedure. Addressing both aesthetic and functional aspects together is an essential factor in improving patient satisfaction.

This was Dr. Peter C. Kang. Thank you.

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