The Role of Skin and Soft-Tissue Excision in the Management of the Bulbous Nasal Tip in Asian Rhinoplasty

Abstract Background Correcting bulbous nasal tips in Asian tip plasty is challenging because of the firm and thick skin soft-tissue envelope (SSTE), and some patients may not achieve the desired results despite reshaping cartilage and bone structures. Objectives The authors of this study evaluate the effectiveness of nasal skin and soft-tissue excision in patients with persistent bulbous tips after unsatisfactory scaffold-based rhinoplasty. Methods From November 2019 to November 2021, the patients with bulbous nasal tips caused by firm and thick SSTE underwent nasal skin and soft-tissue excision after inadequate results from bone and cartilage scaffold reshaping. Any excess skin at the infratip lobule, the nasal columella, and the nasal ala was excised in accordance with established aesthetic proportions. The patients were followed for 12 months, with photographs taken at the final visit. Results A total of 22 female patients were included in the current study. All patients underwent infratip lobule skin resection and interdomal sutures. Additional procedures included partial alar resection (20/22), implant-based rhinoplasty (16/22), pyriform foramen augmentation (14/22), interdomal fat pad resection (13/22), nasal bone narrowing (13/22), and partial columella excision (3/22). Three patients had reduced nasal tip projection, whereas 3 remained unchanged. Two received a cephalic trim for flared lateral crura. One year after surgery, all patients were satisfied with the results. Conclusions Correcting bulbous nasal tips because of the firm and thick SSTE in East Asian patients may require techniques like partial nasal skin and soft-tissue resection, as reshaping cartilage and bone may be insufficient for optimal results. Level of Evidence: 4 (Therapeutic)