Refining a Bulbous, Overextended Nose After Alar Reduction – Secondary Rhinoplasty Case Study

noselab
4월 24일
3분 분량

최종 수정일: 4월 25일

[Nose Lab Clinic]

Hello, this is Dr. Cha-Young Kang, Director of Nose Lab Clinic.

Today, I’d like to share the case of a patient who underwent alar base reduction (nostril narrowing) surgery 12 years ago and came to us with concerns of a bulbous nasal tip and an overall elongated appearance of the nose. Through precise revision surgery, we successfully refined the nasal contour, addressed structural and functional issues, and restored balance to the patient’s facial features.

Design Consultation: Frontal View, Left Side View, and Oblique Side View Photos

📍 Surgical History

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

🔎 Initial Assessment

Design Consultation: Right Side View, Oblique Side View, and Nostril View Photos

1. Frontal View

Bulbous nasal tip
Slightly deviated nose
Downward-pointing nasal shape ("arrow-shaped" tip)

2. Side Profile

Overly long nose appearance
Drooping nasal tip
Subtle hump on nasal bridge
Small nasolabial angle
Protrusive upper lip profile

3. Nasal Base

Asymmetrical nostrils
Columella deviation to the right

4. Functional Issues

Right-sided nasal obstruction, especially noticeable when lying down
No allergic rhinitis history

Nasal Endoscopy Photos

✨ Patient's Goals

Refine the bulbous nasal tip
Reduce the apparent length of the nose
Correct nostril asymmetry
Understands and accepts the limitations of previous alar base surgery

💉 Surgical Plan

1. Structural Assessment and Correction

Careful evaluation of the prior alar base reduction
Septal reconstruction as needed
Correction of nasal deviation

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

2. Shape Refinement

Sculpted the bulbous nasal tip for a more refined contour
Strategically reduced the visual length of the nose
Smoothed the dorsal hump for a soft, straight line

3. Functional Repair

Septoplasty to address septal deviation
Submucosal radiofrequency turbinate reduction to alleviate right-sided obstruction
Improved breathing and airflow

✅ Surgical Outcome

Before (Left) / Immediately After (Right)

1. Frontal View

Sleeker, more defined tip
Corrected columella tilt
Balanced nostril symmetry

Before (Left) / Immediately After (Right)

2. Side Profile

Reduced nasal length
Natural sloped dorsal line
Improved nasolabial angle
Softer, less prominent upper lip projection

Before (Left) / Immediately After (Right)

3. Functionality

Markedly improved breathing
Resolved nasal obstruction, especially when lying down
Structurally stable nasal framework

Before (Left) / Immediately After (Right)

👨‍⚕️ Expert Commentary

Immediately After Surgery: Frontal, Side, and Oblique Side View Photos

Immediately After Surgery: Nostril View Photos

his case involved navigating the limitations of a prior alar base reduction surgery, which can pose significant challenges in revision work due to permanent changes in nostril width and skin tension. During preoperative counseling, I made it clear that while complete reversal of the previous surgery isn’t possible, we could still achieve substantial aesthetic and functional improvements.

The patient had also undergone septal cartilage harvesting in the past where bone portions of the septum were used for tip projection, which can weaken septal support and lead to tip ptosis or deviation over time. To address this, I reinforced the weakened septum using autologous rib cartilage, which allowed for precise control of nasal length and tip projection.

Functionally, the right-sided nasal obstruction was notably improved through a combination of septoplasty and turbinate surgery, which helped expand the internal nasal airway and restore comfort during sleep and daily activities.

This was a successful revision rhinoplasty where both aesthetic refinement and functional restoration were achieved.

This has been Dr. Cha-Young Kang, Director of Nose Lab Clinic.

Thank you.