Bulbous tip noses that have thick nasal tip skin can still be refined despite the thickness of the nasal tip skin. This can be done with tip cartilage shaping, suture techniques, and using cartilage grafts from the septum after septoplasty, even for a deviated septum. The subcutaneous fat and muscle can also be reduced around the tip skin in order to create a more defined tip. However, even with these techniques, the bulbous tip with thick skin is still difficult to refine as much as one with thin skin.