Why the nose looks bulbous and long after alar reduction, and how to correct it

Hello, I am Dr. Peter C. Kang.

Today, I would like to share the case of a patient who improved bulbousness and an excessively long-looking nose that developed after alar reduction surgery.

• 12 years ago: Septal cartilage + silicone implant + alar reduction surgery

1. Front view

• Bulbous nasal tip

• Deviated nose

• Arrow nose

2. Profile view

• Nose appearing long

• Drooping nasal tip

• Noticeable dorsal hump appearance

• Acute nasolabial angle

• Protruding mouth findings

3. Nostrils

• Nostril asymmetry

• Columella deviated to the right

4. Function

• Right-sided nasal obstruction (worse when lying down)

• No allergies

• Improvement of bulbous nasal tip

• Correction of the long-looking nose

• Correction of nostril asymmetry; patient was aware of the limitations due to prior alar reduction

1. Structural improvement

• Assessment of condition following alar reduction surgery

• Septal reconstruction if necessary

• Correction of crooked nose

The removed silicone implant and the septal bone used for septal extension during the previous surgery

2. Shape improvement

• Refining a blunt nasal tip

• Procedures to reduce overall nasal length

• Refining the dorsal hump area

3. Functional improvement

• Septoplasty

• Radiofrequency submucosal resection of the inferior turbinates

• Improvement of right-sided nasal obstruction

1. Front view

• Refined tip shape

• Correction of columellar tilt

• Balanced nostrils

2. Profile view

• Reduced nasal length

• Natural dorsal hump line

• Achieving an appropriate nasolabial angle

• Improved protruding mouth

3. Function

• Improved, unobstructed breathing

• Relief of nasal obstruction

• Stable structure

This revision rhinoplasty had to be performed within the inherent limitations left by the alar reduction surgery done 12 years ago. Before surgery, I explained thoroughly that alar reduction, by its very nature, cannot be completely reversed and carries certain structural limits.

Nevertheless, we successfully refined the bulbous nasal tip and appropriately reduced the apparent nasal length. Correcting the nasolabial angle also improved the appearance of a protruding mouth, and the deviated nose along with the tilted columella were naturally corrected.

In this patient's septum, bone from the septum had been harvested and used as septal extension material in the previous surgery. When septal bone is overly harvested, it severely weakens the septum, which can cause the nasal tip to droop or deviate. Therefore, I performed a sturdy reconstruction of the septal cartilage using autologous rib cartilage alongside the revision to correct the long, drooping nasal tip.

In particular, the right-sided nasal obstruction caused by a deviated septum and rhinitis—which became worse when lying down—was significantly improved through septoplasty and an inferior turbinate procedure, achieving a satisfying functional outcome as well.

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

Thank you.

#closedrhinoplasty #revisionrhinoplasty #bulbousnosecorrection #longnosecorrection #customrhinoplasty