The Importance of Understanding the Causes Before Alar Base Reduction Surgery

We receive numerous inquiries about alar base reduction and bulbous nose surgery. While the appearance of the nose can change with the height of the nasal bridge and tip, achieving a slimmer and more refined look from the front view may require alar base reduction or bulbous nose surgery. I have previously explained the causes of a bulbous nose. Today, I would like to discuss the various methods of alar base reduction surgery.

As mentioned in previous articles, bulbous noses can be categorized into three main types:

1. Excessive subcutaneous fat layer

2. Issues with cartilage being large, spread apart, or underdeveloped

3. Thick skin (difficult to resolve)

Let's explore the alar base reduction surgery methods for each case.

1. Excessive Subcutaneous Fat Layer

Even if the skin at the nose tip is not thick, well-developed soft tissue usually indicates a substantial fatty layer. Surgical experience shows that quite a thick fatty layer is often present, as shown in the photos. Many vital blood vessels are distributed in this area, so meticulous alar base reduction techniques are needed to carefully separate and remove the fatty layer.

Avoiding damage to blood vessels while safely removing the fatty layer helps prevent color changes and scar tissue formation. This procedure requires high surgical skill and should be performed by experienced medical professionals.

2. Issues with Cartilage Being Large, Spread Apart, or Underdeveloped

Large cartilage is mostly a characteristic of Western individuals and applies to only 10-20% of Asians. When the cartilage is large, unnecessary parts are trimmed. If the cartilage is well-developed but spread apart, the “cartilage suturing” technique is used to gather the spread cartilage, narrowing the nose tip.

However, the most common issue with bulbous noses is underdeveloped columellar cartilage, leading to a low columella and a flattened nose tip appearance from the front. To address this, the following steps are necessary:

1. Erecting a cartilage column in the columella to raise the nose tip.

2. Bringing together both sides of the cartilage to narrow the nose tip.

3. If the nose tip height or width is still insufficient, a cartilage graft is performed on the nose tip.
   

Besides alar base reduction, raising the columella can be achieved by erecting a cartilage column between the columellar cartilage or using large cartilage, such as septal or rib cartilage, for a septal extension graft.

The surgical method varies based on the individual’s cartilage and available materials, so it is advisable to take a CT scan beforehand to assess the cartilage condition and plan the surgery accordingly.

3. Thick Skin

Cases with thick skin are challenging and often have lower satisfaction rates. Such skin is typically characterized by highly developed sebaceous glands and frequent acne, leading to repeated inflammation and thickening. In these situations, all possible alar base reduction techniques should be attempted. Maximizing cartilage support and removing as much thickened fatty tissue as possible helps achieve a slimmer nose tip appearance.

Achieving a refined look for a bulbous nose requires various alar base reduction methods. Additionally, factors like nostril symmetry, post-surgery scars, and overall facial balance must be considered. Therefore, careful decision-making is crucial, and a CT scan should be conducted to understand the internal structure of the nose and formulate a surgical plan.

#rhinoplasty #bulboustip #alarreduction #ATOPPS

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Dr. Lee Han Jeong

Chief Director at ATOP Plastic Surgery