Prevention and Correction of Nasal Tip Bossae in Rhinoplasty

Abstract

To describe our experiences with nasal tip bossae, suggest a standard nomenclature, discuss causative factors, and provide a comprehensive, analytic approach to the prevention and correction of bossae.Background: Nasal tip bossae are knoblike protuberances of the alar cartilages that can arise after rhinoplasty. Early bossae are due to uncorrected or inadvertently created asymmetries, while late bossae are due to fibrosis and scar contracture acting on a weakened or unreconstituted cartilaginous framework. Numerous techniques may be used to prevent and treat bossae; however, we found no article in the existing literature that presents an in-depth, analytic description of management techniques.Methods: We analyzed the predisposing factors and techniques leading to bossa formation and studied principles of prevention and correction. All rhinoplasty cases that presented for revision from 1985 through 2000 were reviewed for bossae formation via internal computer search. Previous operative records for rhinoplasty cases were examined when available. Intraoperative notes and photgraphs of the revision surgery were examined.Results: Etiologies for bossae were consistently found, and successful treatment modalities were noted.Conclusions: Nasal tip bossae are most often due to dynamic forces acting on iatrogenic changes and/or weakness in the alar cartilages. By minimizing cartilage excision, reinforcing areas of weakness, avoiding asymmetry and irregularity, and maintaining alar integrity, formation of bossae may be prevented. The treatment of bossae must be individualized and can range from simple suture stabilization techniques to complex domal cartilage replacement grafts, depending on the observed defect.

Asymmetric Nasal Tip

“…21 Although this technique is simple and initially effective, Kridel et al warn that this method only serves to weaken the LLC and distort the nasal tip framework, which predisposes to further nasal bossae formation. 10 In our experience, direct excision of a nasal bossae without reconstitution of strip integrity is a setup for unpredictable healing and should be avoided. Morselizing or scoring cartilage irregularities to soften their contour are other techniques that may be used to treat nasal bossae.…”

“…Although bossae may be congenital or traumatic in origin, most are seen in the postrhinoplasty patient. 10 Early presentation within several months can be attributed to either preexistent LLC asymmetries that were unmasked (and uncorrected) during surgery or created iatrogenically. For example, excessive cinching of a transdomal suture can iatrogenically introduce an immediate postoperative nasal bossae.…”

Die Korrektur der bulbösen Nasenspitze

“…Dabei durchtrennen wir die Dome vertikal. Dann werden sämtliche Knorpelkanten im Sinne von Kridel [11] miteinander vernäht und dadurch die Nasenspitze neu geformt (. Abb.…”

Complications in Rhinoplasty

“…Late bossae usually appear a few years after surgery and are due to fibrosis and scarring over a weakened cartilaginous framework. 36 Certain patients carry a higher risk for forming bossae postoperatively. Females, young patients, patients with thin skin, and those with a bifid nasal tip have a tendency to develop bossae when undergoing the same maneuvers as other patients.…”