Bulbous Tip Correction Focusing on Skin Soft Tissue Envelope in Asian Rhinoplasty

A bulbous nasal tip is commonly seen in Asians; its correction represents a significant portion of Asian rhinoplasties. Bulbous tip correction in Caucasians mainly aims at reducing excess lower lateral cartilage and performing suture techniques on well-developed lower lateral cartilage [1-4]. Asians with a bulbous tip have a small, weak lower lateral cartilage and nasal septum [5,6]. Therefore, there is a limit to how much one can project the lower lateral cartilage and push against the nasal tip skin and soft tissue, the so-called SSTE (skin soft tissue envelope). In addition, there is a high incidence of nasal SMAS (superficial musculoaponeurotic system) thickening [1]. Thus, reshaping and repositioning the lower lateral cartilage are often masked by a thick nasal skin envelope [1,2,7,8]. In Asians, one must incorporate SSTE thickness when defining a bulbous tip. A simple surface evaluation of a broad or large nasal tip is insufficient to describe a bulbous tip. Classification using cartilage shape was previously introduced in the literatures [2,3,5], but such a definition provides a limited description of the actual appearance of the bulbous tip. Some authors have shown interest in SSTE and tried to explain “bulbous” as the unfavorable shadowing Da Arm Kim, Jae Yong Jeong, Sang Ha Oh