Differences Before and After Bulbous Nose Surgery: A Specialist’s Perspective on Improvement Strategies for Each Case
- Dr. Lee Han Jeong
- Jul 18, 2024
- 3 min read
There used to be a saying that a wide and thick nose brought good fortune, so one should never touch it. However, as times have changed and standards of beauty have evolved, a sleek and smaller nose tip is now often seen as more appealing than a wide and flat nose.
Many of our patients bring photos of K-pop idols or celebrities, expressing their desire for similar nose shapes. For many East Asians, who often have round and flat noses, rhinoplasty combined with alar base reduction may be necessary.
While rhinoplasty can alter the height and shape of the nasal bridge and tip, bulbous nose surgery can make the face appear more defined and smaller simply by reducing the width of the nose.
Today, I would like to discuss how to choose the right improvement method based on different types of bulbous noses, illustrated with before and after photos.
The various types we need to consider include:
Thick fatty tissue
Excessively large alar cartilage
Weak alar cartilage development at the columella, causing a spread
Spread cartilage structure
Wide alar base
Firm and thick skin
Thick Fatty Tissue
When the fatty tissue is thick, some of it must be removed. Even if the internal cartilage is well-positioned, thick overlying skin and soft tissue will still make the nose tip appear large. Just as one would wear a lighter jacket for style in winter rather than a heavy one, removing the excess fat is necessary.
However, excessive fat removal can thin the skin too much, impairing blood circulation and causing skin discoloration or necrosis. Therefore, it is crucial to remove the fat precisely and accurately.
Experience is particularly important here. Once the fat is removed, the thinner skin may reveal or pinch the underlying cartilage, requiring careful cartilage suturing or grafting. Before and after photos will show how the correction was made and its results.
Excessively Large Alar Cartilage
When the alar cartilage is overly developed, it can make the nose tip look large. In such cases, trimming the enlarged alar cartilage to an ideal shape can improve the appearance. However, most Asians do not have such large alar cartilages, so a lateral crura spanning suture technique often suffices to narrow the cartilage and slim the nose tip.
Weak Alar Cartilage Development at the Columella
If the columella is short and the nostrils and nose tip appear spread, it resembles a flattened nose. Like an umbrella with a short central shaft, the central structure must be reinforced to support the columella properly.
The material used for this reinforcement affects the surgical method, which is crucial in both correction and rhinoplasty. Before and after photos will show the significant changes made by properly supporting the columella and reducing the alar base.
Spread cartilage structure
If the cartilage is spread, making the nose tip look wide, the gap between the cartilages needs to be narrowed. This requires a detailed analysis of the cartilage structure. Sometimes, simply gathering the middle bridge of the alar cartilage can suffice, but often, like in our before and after photos, weak internal alar cartilage development necessitates strengthening the columella.
Simply tying the cartilage together can lead to a pinched or ineffective result, so appropriate cartilage suturing and soft cartilage grafting may be necessary.
Wide alar base
A wide alar base, rather than an issue with the nose tip or alar cartilage, can exacerbate the appearance of a bulbous nose. In these cases, reducing the width of the alar base is essential. As the final touch, considering the alar base is crucial for achieving perfect proportions. Common methods include internal and external incisions.
However, reducing only the alar base without correcting the nose tip can make the tip appear wider, worsening the bulbous appearance. It is best to balance the nose tip and alar base, as shown in our before and after photos.
Firm and thick skin
While most causes mentioned above can be corrected, thick skin poses a unique challenge. Even with extensive rhinoplasty experience and skill, it is difficult to achieve a perfect result if the skin is thick.
Reducing the internal soft tissue might not be noticeable if the skin remains thick. Thick skin, especially with developed sebaceous glands, can leave a bulky or uneven appearance, often resulting in lower satisfaction. It is important to manage expectations and consider the possibility of post-surgery acne and other skin issues, necessitating continuous treatment.
Alar base reduction surgery is not merely about reducing the alar base. Comprehensive correction, including bulbous nose correction, nose tip surgery, and reshaping the nasal bridge, is essential for a natural and harmonious result. If you are concerned about the shape or sagging of your nose or alar base, we recommend visiting our clinic for a CT scan and consultation.
Dr. Lee Han Jeong
Chief Director at ATOP Plastic Surgery
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