See how a lower lateral cartilage cephalic trim can be used to treat a bulbous tip
Dr. Lamperti narrates an intra-operative video showing how he performs a cephalic trim of the lower lateral cartilages in order to treat a bulbous nasal tip. He also reviews the basic anatomy of the nasal tip.
"This is Seattle facial plastic surgeon, Doctor Thomas Lamperti. Today I'm going to go over a video to show how we perform a cephalic trim to treat a bulbous nasal tip. First let's go over some basic anatomy. This schematic shows the nasal tip anatomy, namely the lower lateral cartilages on either side. It is here where we'll be placing our incision. This incision shows where the incision line are placed. You can see that it is the small strip of cartilage above these incisions that is the tissue that we will remove. Now let's go ahead and see the intra-operative video of the cephalic trim being performed. This patient has a quite bulbous tip an you can see that we are making the incision first on the right side in that areas of the lower lateral cartilage like I described. Once the incision is made we then continue to trim the cartilage off of the underlying nasal vestibular mucosa or skin lining. We continue to remove this tissue and ultimately we'll be able to a less bulky appearance to that side of the tip. Next we'll repeat the procedure on the left side as well. People often wonder how much cartilage is left and how do you figure out how much cartilage to remove. I'm quite conservative in this process and the main idea is to maintain equal amounts of lower lateral cartilage once you're done. So since sometimes there are asymmetries in how much is there doesn't necessarily mean that we'll be removing the same amount on either side. I typically leave at least 8 millimeters at the widest point of the lower lateral cartilage and approximately 5 millimeters towards the domes. If additional refinement of the tip is needed I'll use additional maneuvers to refine the cartilages including dome binding or lower lateral crural strut grafts. It is important not to over-resect the cephalic cartilages in order to compensate for persistent bulbosity."