Bulbous nasal tip: an anatomical and histological evaluation.

The operative management of the bulbous nasal tip is a challenging and unsolved problem. Surgical alteration often leads to disappointing postoperative results. Surgical options for the soft tissue range from tip defatting and scoring of the dermis to no soft-tissue removal at all. The goal of this study was to determine anatomically and histologically the exact nature of the nasal tip soft tissue. Forty-two tissue specimens were obtained from 23 patients undergoing nasal surgery. These specimens were stained with standard hematoxylin and eosin stain and a combined Mallory trichrome and elastic stain and examined under light microscopy by a pathologist. Qualitative assessment of the tissue types present demonstrated that collagenous fibrous tissue was abundant. Skeletal muscle was present in significant amounts and in some cases made up the majority of the subdermal tissue. The adipose tissue component was less than expected.