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    Bulbous nasal tip reduction: How do you measure?

    A simple, yet objective, technique for measuring the reduction of the bulbous tip postoperatively in ethnic rhinoplasty has been validated in a study in Annals of Plastic Surgery.

    “A major concern of ethnic rhinoplasty patients is a bulbous fatty nasal tip,” says principal investigator Oheh Slupchynskyj, M.D., founder and director of The Aesthetic Facial Surgery Institute of New York and New Jersey. “I have a large population of rhinoplasty patients with bulbous tips and wanted to create an objective way to evaluate postoperative results.”

    The study was a retrospective analysis of 44 nonwhite patients who underwent open rhinoplasty, including nasal tip defatting and cartilage graft placement.

    Postoperative photographs in the subnasal view were evaluated.

    With a submental vertex view of the nasal base, Dr. Slupchynskyj and colleagues were able to identify a new nasal landmark, cl (c prime), “which is the widest part of the nostril defined from the point where the alae and lateral margin of the lower lateral cartilages meets the tip,” Dr. Slupchynskyj tells The Aesthetic Channel.

    This landmark is important to cosmetic surgeons because “surgeons can scientifically define bulbous tip results and design objective studies of bulbous tip reduction in rhinoplasty patients,” Dr. Slupchynskyj says.

    Related: New clinical practice guideline for rhinoplasty

    The study also found a statistically significance difference in pre- and postoperative values with the new method by assessing preop and postop pictures to measure angles, distances and areal indices with a polygonal construct, including both the new anatomic landmark and established landmarks.

    Dr. Slupchynskyj says that this is the first study to use an objective method to evaluate ethnic bulbous tip rhinoplasty results, with statistically significant confidence.

    “Ethnic rhinoplasty is by far the most complex and challenging of all rhinoplasty procedures,” Dr. Slupchynskyj says. 

    The published article also describes Dr. Slupchynskyj's surgical technique to refine the bulbous nasal tip in ethnic rhinoplasty patients with objectively measurable results.

    “However, more objective scientific studies need to be conducted in ethnic rhinoplasty because most publications on bulbous tip reduction are anecdotal,” Dr. Slupchynskyj says.


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