Doctor's Column

Among those considering revision rhinoplasty, many feel that their alar base looks wider or feels more stuffy rather than having issues with the bridge or tip. Especially in cases with a past history of implant surgery, changes in the central structure of the nose can make the alar base relatively more pronounced. Through the case of a patient one month post-revision rhinoplasty, this article structurally explains why the alar base appeared more prominent and what role alar reduction played in the overall impression of the nose.

SH Plastic Surgery Facial Designer Director Sung-hoon Kim

Hello, this is Director Sung-hoon Kim of SH Plastic Surgery.

During revision rhinoplasty consultations, I often hear people say, "My nose is definitely elevated, but the overall line somehow looks awkward..." In particular, there are many cases where the alar base looks stuffy from the front, or the tip droops weakly in the profile view.

The reason is that the overall balance of the nose cannot be achieved with the bridge alone.

Today, through a revision rhinoplasty case of a patient who visited us with these concerns,

I will explain why we must look at the nasal bridge, tip, and alar base together.

Patient Case Introduction

Revision Rhinoplasty Patient

Main Concern: The alar base began to bother the patient more after implant replacement

Surgical History: Nasal bridge implant surgery in December 2021

The most memorable remark during the consultation was:

"My nose became higher, but looking from the front, the alar base looks more spread out."

In revision rhinoplasty consultations,

The point at which the alar base becomes a greater dissatisfaction than the bridge

Is a situation encountered more often than you might think.

Why does the alar base look wider after surgery?

"It is not that the alar base has become larger, but that the center has shifted."

In this patient's case,

The alar base itself was not an excessively large structure.

The problem was that,

After the nasal bridge implant surgery,

As the central axis of the nose became emphasized,

The width of the alar base and nostrils appeared relatively more prominent.

In other words,

The alar base did not actually grow larger;

Rather, the proportion that the alar base occupied in the frontal impression had increased.

If the alar base is left untouched in such cases,

No matter how well the tip and bridge are refined,

An "impression of a stuffy-looking nose" remains from the front.

Alar reduction is not just an 'operation to make it smaller'

The key is not the width, but the 'facial impression ratio'

Many people think of alar reduction

simply as a "surgery to reduce the alar wings,"

but in reality, it is closer to a surgery that cleans up the frontal impression.

In this case, the goal of alar reduction was

not to reduce it excessively,

but to balance the left and right width,

stabilize nostril exposure,

and adjust it to connect naturally with the nasal tip.

① A design considering both the inner and outer alar base

So that scars are not visible from the front

Approaching mainly through the inner alar crease

Minimizing left-right asymmetry

② The reason for avoiding excessive reduction

Reducing it too much can make the impression sharp

Awkwardness may occur when smiling

Increases the risk of widening again in the long term

Why alar reduction was absolutely necessary in this case

After the rhinoplasty, the presence of the alar wings looked prominent from the front,

there was a strong pulling force spreading the nostrils outward when smiling,

and even if the tip line was refined, there was a possibility that the overall impression would look blunt.

If the alar wings had not been refined,

this is a case where the feeling of "the nose is fixed, but somehow still looks awkward" would have remained.

The reason why silicone implant replacement was necessary

"The height was created, but the line was not completed"

Looking at the photos from the previous surgery,

the nasal bridge was sufficiently raised with a silicone implant,

but the tip support structure was weak,

so the tip drooped downward in the side profile.

The common problems that appear in such cases are:

✔ The bridge and tip of the nose do not connect naturally,

✔ The center of gravity of the nose leans forward, and

✔ From the front, it gives the impression that the alar (nostril area) looks more spread out.

Therefore, in this revision surgery,

rather than simply maintaining the implant or adjusting the height,

a process of replacing the existing silicone and reshaping the overall line was necessary.

The reason why silicone replacement + nasal tip reconstruction were performed together

Silicone implants

do not merely serve the purpose of "raising the height of" the nose;

depending on how they connect to the nasal tip,

they determine the overall impression.

In this patient's case,

With the existing implant, only the bridge was emphasized,

and support was not naturally transferred to the nasal tip,

resulting in a structure where the line appeared broken in the middle.

Therefore, in this surgery,

the silicone was replaced to smoothly refine the nasal bridge line,

and the nasal tip was rebuilt using septal cartilage and ear cartilage,

designing it so that a single curve connects from the nasal bridge to the nasal tip.

As a result,

the bridge became smooth without being overdone,

and with the nasal tip firmly supported without drooping,

a stable line was achieved from both the side profile and the front view.

Change in the nasolabial angle

Before surgery, the support for the nasal tip was weak, causing the nasolabial angle to look acute/closed,

giving a strong impression that the nasal tip was pulled downward.

Because of this, the nose looked heavy and stuffy from the side profile, and it had a structure that gave the impression that even the area around the mouth was drooping together.

After surgery, as the support structure for the nasal tip stabilized, the nasolabial angle opened naturally,

and the line extending from the nasal bridge through the nasal tip to the philtrum was smoothly refined.

Without making the angle excessive, it was adjusted within a range that suits the face,

We were able to complete a much lighter and neat profile without an artificial feel.

Director Kim Sung-hoon's Surgical Review

Alar reduction is not simply a surgery to make things smaller.

In particular, for revision rhinoplasty patients, the alar base often appears relatively more prominent after changes to the nasal bridge or tip.

In such cases, leaving the alar base as it is will leave the overall impression of the nose unrefined.

Rather than just making the alar base 'small', I focus on adjusting its proportion to the rest of the face.

A result that is not excessive and remains stable for a long time is ultimately the most natural.

❓ FAQ (7 in total)

Q1. Does alar reduction always have to be performed with revision rhinoplasty?

A. It is not mandatory, but it is recommended to consider them together if the frontal impression feels stuffy or heavy.

Q2. Are the scars from alar reduction noticeable?

A. They are hidden within the natural creases, making them almost invisible from the front.

Q3. Doesn't reducing the alar base make one's impression look harsh?

A. Unless it is excessively reduced, it actually refines and neatens the impression.

Q4. Does it look awkward when smiling?

A. It is not a problem if it is designed with the dynamic movements of smiling in mind.

Q5. Is there a possibility that it will widen again?

A. If reduced within an appropriate range, the possibility of re-expansion is low.

Q6. Can the results be evaluated at one month post-surgery?

A. While significant changes are visible, final stabilization requires a bit more time.

Q7. Can alar reduction be performed alone as a standalone procedure?

A. Depending on your anatomical structure, a standalone surgery is fully possible.

At SH Plastic Surgery,

we do not view alar reduction merely as an 'auxiliary surgery.'

In terms of the frontal impression,

we reduce the heavy, stuffy look

and approach it as an important process to balance the entire nose.

Especially after revision rhinoplasty,

if you feel that "the nose is refined, but something still feels awkward,"

the reason may lie in the alar base.