Remaining structures and reconstruction methods after alar reduction

Hello, I am Dr. Peter C. Kang.

Today, I would like to share a case where problems that developed after multiple rhinoplasties and excessive alar reduction were corrected.

• 10 years ago: Bulbous nose surgery using ear cartilage and a silicone implant

• 6 years ago: Surgery using ear cartilage, a silicone implant, and septal cartilage

• 3 years ago: Surgery using donor rib cartilage, a silicone implant, and alar reduction

• Rhinitis surgery

• Nasal obstruction, more severe on the left side

• Lowering the radix

• Nose that does not appear long

• Natural nasal tip that is not pointed

• Creation of a straight bridge line

• Improvement of asymmetry

• Lowering the columella

1. Front view

• Bulbous nasal tip

• Crooked nose

• Poorly defined tip contour

• Unnatural nasal shape

2. Profile view

• Columella not visible at all

• Bulbous nasal tip

• Unnatural nasal shape

3. Oblique view

• Prominent implant outline

• Bulbous nasal tip

• Drooping tip

4. Nostril view

• Severe scarring from alar reduction

• Nostril asymmetry

• Smaller nostrils

• Columella tilted to the left

1. Septal extension using autologous rib cartilage

2. Correcting the nasolabial angle by lowering the columella

3. Partial removal of subcutaneous tissue and scar tissue from the nasal tip to correct the bulbous tip

4. Reconstruction of both alae to create a natural nasal tip contour

5. Deviated septum correction and rhinitis surgery performed to improve nasal obstruction

1. Front view improvement

• More defined nasal tip contour

• Natural nasal shape

2. Profile view improvement

• Radix naturally lowered

• Nasal tip shape improved as the columella was lowered

• Improvement of protruding mouth through nasolabial angle correction

3. Oblique view

• Refined straight bridge line

• Natural three-dimensional definition

4. Nostril view improvement

• Improved asymmetry

• Tilted columella straightened

This case was a reconstruction performed after excessive alar reduction, and we were able to achieve the intended result despite the limited conditions. However, I want to emphasize that this was an exceptionally challenging process.

Alar reduction is a procedure that is difficult to reverse once performed. Excessive reduction permanently alters the size and shape of the nostrils, substantially limiting the possibilities for subsequent reconstruction. In particular, patients with a bulbous nose should make decisions regarding alar reduction with extreme caution.

I always emphasize this point: alar reduction is a surgery best avoided whenever possible. Even when inevitable, it should be kept to a minimal degree, with thorough consideration given to complications that may arise in the future.

I will continue to strive for the intended results even in such limited circumstances; however, I would like to emphasize once again that prevention is the most effective approach.

This was Dr. Peter C. Kang. Thank you.

Thank you.

#revisionrhinoplasty #alarreductioncomplications #nasalreconstruction #straightbridgeline #customrhinoplasty