Bulbous Tip Correction and Nasal Length Refinement After Alar Reduction: Secondary Rhinoplasty Case

📍 Understanding the Case: Challenges After Alar Base Reduction

Twelve years after undergoing alar base reduction and implant-based rhinoplasty, the patient returned with concerns about a bulbous nasal tip, overextended nose length, and nostril asymmetry.

This case required not only cosmetic revision but also bulbous tip correction with functional breathing repair.

Preoperative design consultation photos: Frontal view, left oblique side view, and left side view.

🔎 Preoperative Findings and Functional Issues

Preoperative design consultation photos: Right side view, right oblique side view, and nostril view.

1. Frontal View

• Bulbous nasal tip

• Slight deviation

• Arrow-like downward tip

2. Side Profile

• Overly long nose

• Drooping tip and dorsal hump

• Small nasolabial angle

• Protruding upper lip

3. Nasal Base

• Nostril asymmetry

• Columella deviated to the right

  

  Nasal Endoscopy Photos

4. Breathing Function

• Right-sided nasal obstruction when lying down

• No allergy history

✨ Patient Goals

• Define and refine the bulbous nasal tip

• Shorten the appearance of the nose

• Correct nostril asymmetry

• Realistic expectations after irreversible alar base reduction

💉 Surgical Plan for Bulbous Tip Correction and Nasal Balance

1. Structural Repair

• Review of prior alar base reduction impact

• Septal reconstruction using rib cartilage

• Correction of nasal deviation

Removed Silicone Implant and Septal Bone Used for Septal Extension in Previous Surgery

2. Shape Refinement

• Bulbous tip correction with precise cartilage reshaping

• Dorsal hump smoothing

• Controlled shortening of nasal length

3. Functional Repair

• Septoplasty

• Turbinate reduction (radiofrequency)

• Expansion of right nasal airway

✅ Surgical Outcome

Before (Left) / Immediately After (Right)

1. Frontal View

• Refined nasal tip

• Straighter columella

• Balanced nostrils

Before (Left) / Immediately After (Right)

2. Side Profile

• Reduced nasal length

• Straighter dorsal line

• Softer lip projection

• Enhanced nasolabial angle

Before (Left) / Immediately After (Right)

3. Functionality

• Significantly improved breathing

• Symptom-free sleep

• Stable structural support

Before (Left) / Immediately After (Right)

👨‍⚕️ Expert Commentary: Limits and Solutions in Secondary Rhinoplasty

Immediately after surgery: Frontal view, side view, and oblique side view photos.

Immediately after surgery: Nostril view photos.

This revision required understanding the permanent anatomical changes caused by alar base reduction, which can restrict correction.

Previous septal harvesting had weakened internal support, increasing the risk of tip droop or deviation.

By using autologous rib cartilage, we reinforced the septum, enabling secure nasal shortening and precise bulbous tip correction.

Breathing was improved through internal structural correction.

Conclusion: Aesthetic and Functional Success in Bulbous Tip Correction

This was a successful secondary rhinoplasty that balanced cosmetic refinement and functional recovery.

Through advanced reconstruction techniques, we achieved long-term improvement for both appearance and airway comfort.

Dr. Cha‑Young Kang | Nose Lab Clinic, Seoul

Specialist in Closed Rhinoplasty & Revision Surgery

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