The nose is made up of a fixed and rigid part that is called nasal pyramid, although it rather has the shape of a tent or roof, and a pliable mobile part which is the nasal tip, the alae and its annexes. The nasal tip and the alae are structured by the so called alar or lower lateral horseshoe shaped cartilages with their lateral and medial crura or crus and accessory cartilages, the domes between lateral and medial cruras, the interdomal fibrofatty pad, the caudal or lower septum and the skin of the alae.
Both halves of the nasal tip join with each other in the center of the tip to form a tripod in which the lateral legs are the lateral cruras of the alar or lower lateral cartilages and the central leg the union of both medial cruras of the alar or lower lateral cartilages.
We consider the nasal tip is bulbous when its external look is objectively or subjectively oversized and has to be modified to achieve a proportionate and harmonious reduction in size of all the anatomical nasal tip structures affected, either by closed or open approach rhinoplasty techniques, however most commonly by open rhinoplasty and structure rhinoplasty techniques, which might be caused by one or more of congenital or ethnically conditioned oversized cartilages, excessive fibrofatty pad, thick skin, poor tip support, untreated anatomical nasal issues, aging, etc. This leads to a typical large tip with absence of the essential anatomical balance with the face, lack of suitable femininity in women and an unsightly look in men.
Treatment of oversized nasal tip has to be customized to each individual situation, being the main pillar the techniques of alar or lower lateral cartilages trimming, deprojection, plasties, plications (shaping sutures through the cartilages), nasal tip grafting, with or without reinforcement of tip support with columellar strut.