A bulbous nose, also called a wax apple nose or fleshy nose, is characterized by a plump, round, and ill-defined nasal tip, which is disproportionate to the nasal bridge width and looks like a lollipop from the frontal view. This is mostly attributed to the hypertrophy of congenital skin and excess nasal fat or the concurrent flare of alar cartilage. Correction focuses on the partial trimming of the nasal tip skin and soft tissue and reduction of the alar cartilage. Nevertheless, based on Dr. Chuang’s experience in the management of a bulbous nose, mere thinning of the nasal tip fat renders indistinct results. A majority of patients will undergo open rhinoplasty, including the augmentation of the nasal bridge with a nasal implant, elongation of the nasal tip with autologous nasal septal cartilage, support of the marble-shaped nasal tip, removal of the nasal fat and soft tissue (thinning), or reduction of the ala nasi and nostrils, to obviously reconstruct the whole nose. However, because the nasal fat can only be partially removed, patients should not blindly demand an exceedingly small tip. Otherwise, an excess removal of the nasal fat will result in nasal tip skin atrophy or redness and thinning, thus undermining the surgical results and naturalness. Moreover, some patients with scarring are predisposed to intranasal scar proliferation after the operation, leading to secondary hypertrophy of the nasal tip. If necessary, intra-nasal steroid injections to remove scars are administered for the treatment and control of scarring.
Additionally, a bulbous nose is associated with the width of the nasal bridge in some cases. Patients with a flared nasal tip due to an exceedingly wide bridge should consider concurrent nasal bone reduction (lateral osteotomy) to reduce the nasal bridge for attaining multiple results of nasal tip reduction.