Before & After Bulbous Nose Surgery: Key Differences

Hello! 😊 I’m Dr. Han-Jeong Lee, board-certified plastic surgeon and director of ATOP Plastic Surgery.

There was once a belief that wide, rounded noses brought good fortune, and thus altering the nose was discouraged. However, as beauty standards have evolved over time, slimmer and more refined noses with smaller nostrils are now widely considered more attractive and youthful.

Many of our patients bring in photos of celebrities or idols, hoping to achieve a similar nose shape. In East Asian populations, it’s common to see rounder, wider nasal shapes. Therefore, it’s often necessary to perform both rhinoplasty and alar reduction (nostril reduction) together to achieve the desired result.

While nose surgery changes the height and shape of the nasal bridge and tip, a key benefit of bulbous nose correction is the dramatic improvement seen from the front view. Narrowing the nostrils alone can make the face appear smaller and more balanced.

Today, I’d like to review before-and-after cases and discuss which surgical options are most suitable for each nasal type.

These are the key types to identify before surgery.

1. Thick Fat Layer (Hypertrophied Soft Tissue)

2. Overdeveloped Alar Cartilage

3. Underdeveloped Alar Cartilage Near the Columella

4. Naturally Splayed Cartilage Structure

5. Wide Alar Base

6. Thick and Firm Skin

1. Thick Fat Layer

In cases where the fat layer is thick, it’s essential to remove a certain amount of fatty tissue for effective reshaping. Even if the underlying cartilage is sculpted well, a thick layer of overlying skin and soft tissue will still make the nasal tip appear bulky—just like wearing a lightweight padded jacket instead of a heavy one gives a more refined silhouette in winter.

However, if too much fat is removed to the point where the skin becomes overly thin, it can compromise blood circulation, potentially leading to skin discoloration or necrosis. That’s why it’s crucial to remove the fat precisely and within the correct anatomical layer.

This step particularly requires a surgeon’s experience and refined technique. Once the fat is removed, the skin may become thinner and the underlying cartilage more visible or pinched. In such cases, the cartilage must be secured with delicate suturing or grafting techniques to ensure smooth and natural contours.

By examining before-and-after photos, you can see how these corrections are performed and how they lead to balanced and aesthetically pleasing results.

2. Overdeveloped Alar Cartilage

In cases where the alar cartilage is excessively developed, the nasal tip may appear large and rounded due to the sheer size of the cartilage.

In such situations, part of the enlarged cartilage can be trimmed to create a more refined and balanced shape.

However, in most Asian patients, the alar cartilage is not typically large enough to require excision. Instead, a technique called the lateral crura spanning suture, which brings the cartilage closer together, is often sufficient to reduce the width and achieve a slimmer nasal tip.

3. Underdeveloped Alar Cartilage Near the Columella

When the columella is short and the tip appears flattened, the columella is short, causing the tip to appear compressed and the nostrils and alar base to look spread out. Think of it like an umbrella with a short central pole and handle — the structure lacks proper support, leading to a flattened appearance.

To correct this, the columella must be reconstructed and firmly supported, typically with grafting materials. The choice of material will determine the surgical approach, and this step is considered one of the most critical aspects of rhinoplasty—not just for correction, but for achieving a stable, long-lasting result.

When you look at before-and-after photos, you’ll see how properly building the columella and narrowing the alar base can bring about a noticeable and balanced transformation.

4. Naturally Splayed Cartilage Structure

A wide nasal tip can often result from excessive spacing between the alar cartilages.

To address this issue, a detailed analysis of the cartilage shape and positioning is essential.

If only the central portion of the alar cartilages are flared, the problem may be resolved by simply suturing them closer together. However, the inner parts of the alar cartilages are underdeveloped as well, making it necessary to reinforce the columella with grafts for adequate tip projection and support.

Blindly narrowing the cartilages with sutures alone can sometimes cause a pinched tip or result in minimal improvement. Therefore, a balanced approach combining precise suturing and soft cartilage grafting may be required to achieve a natural, refined outcome.

5. Wide Alar Base

In some cases, the bulbous appearance of the nose isn’t due to the nasal tip or alar cartilages, but rather because the alar base itself is overly wide. When the nostrils flare outward, it can make the nose appear even broader and more bulbous.

In these cases, narrowing the width of the alar base is essential to achieving a more refined and balanced nose shape. Although it may seem like a small detail, the alar base plays a crucial role in completing the overall proportion—it’s the final touch that can perfect the harmony of the nose. Common methods to reduce the alar base include internal incisions and external incisions along the alar crease.

However, it’s important to note that if alar base reduction is performed without properly correcting the nasal tip, it can actually emphasize the bulbous appearance, making the nose look even wider. Therefore, as seen in many bulbous nose correction cases, it’s best to consider both the nasal tip and alar base together to achieve balanced, aesthetically pleasing results.

6. Thick and Firm Skin

Most of the causes mentioned above can be effectively corrected through surgery. However, when it comes to thick skin, even the most skilled and experienced surgeons may find it challenging to achieve near-perfect results.

This is because no matter how much soft tissue is reduced inside the nose, if the skin itself is thick, the improvement may not be visibly noticeable. In cases where thick skin is also accompanied by overactive sebaceous glands, the nose can retain a heavy or uneven appearance, which often leads to lower patient satisfaction. It’s important to set realistic expectations and consider this carefully before undergoing surgery.

Additionally, patients with thick skin are more prone to acne or skin irritation after surgery, so ongoing skincare or dermatological treatment may be necessary throughout the recovery period.

Many people think of alar base reduction as a simple procedure that only involves narrowing the nostrils. However, in order to achieve a balanced and natural-looking result, it must often be combined with other corrections such as tip refinement, bulbous nose correction, or even dorsal line adjustment.

When the entire shape, volume, and proportions of the nose are taken into account, alar base reduction can enhance overall harmony without looking awkward or overdone.

If you’re concerned about wide nostrils or drooping at the alar base, we recommend a personalized consultation and CT scan, so we can accurately analyze the underlying structure and design the most suitable surgical approach for your needs.

For customized information, please contact us on WhatsApp at +82-10-4997-0801.

Thank you very much! 😊