Doctor's Column

This is a case where the patient visited contemplating alar reduction, but in reality, the structure of the nasal tip took priority over the alar base. If the nasal tip is large and the alar base is small, performing an alar reduction first can actually make the impression unnatural. Based on actual consultations and before-and-after photo analyses, this article explains with anatomical and scientific evidence why this patient needed nasal tip correction and nasolabial angle improvement rather than an alar reduction.

Hello.

I am Dr. Seong-Hoon Kim, Facial Designer at SH Plastic Surgery.

"I want to recover in about two days and simply become prettier.

I came here thinking about getting an alar reduction."

This is something I hear often in the consultation room.

A short recovery period, a surgery that seems relatively low-burden.

That's why many people think of alar reduction first.

However, this patient's nose

was close to a structure where an alar reduction should not be performed.

CASE

<Front View>

Nasal tip appears round and wide (tip bulbosity)

Ratio of the nasal tip compared to the alar base is large or similar

Columella is barely visible or appears short

Sensation of the alar base spreading horizontally even without smiling

<Profile View>

Before surgery, the angle appears closed and the nasal tip appears to drop toward the mouth

Nasal tip is dully drooping

Nasal bridge seems present, but the tip feels bent downward

Commonly referred to as a "nose that drops from the tip"

Nasal bridge line exists, but it bends rather than flowing naturally into the nasal tip

Diagnostic Points During Consultation

"The problem was not the alar base; the nasal tip was the core issue"

The structural characteristics confirmed through consultation and examination were as follows:

The alar base itself is not large

Rather, the nasal tip is large and the center of gravity leans downward

The columella appears drooped, and the nasolabial angle appears closed

From the side, the nasal bridge is present, but the tip gives an impression of dropping downward

Accompanied by a deviated septum

If alar reduction is performed first in this structure:

From the front, the alar base may appear smaller, but

The bluntness of the nasal tip becomes more emphasized,

and there is a high possibility that the overall facial proportions will actually look awkward.

This is a point that rhinoplasty textbooks and numerous international papers

commonly point out.

Preoperative Analysis

Frontal view: Nasal tip width is more emphasized than the alar base (nostril wings)

Profile view: Reduced nasolabial angle, downward drooping of the nasal tip

Nasal bridge–A structure where the tip line appears interrupted in the middle due to a deviated septum

Key judgment at this stage

"A nose that should not undergo alar reduction"

Why was the nasal tip the priority instead of alar reduction?

There are two reasons why the nostril wings may look wide:

When the skin and cartilage of the alar base are actually large

When the support of the nasal tip is weak, causing the center to collapse

This patient corresponded to case #2.

Because the supporting structure for the nasal tip was weak,

the center of the nose sagged downward,

and as a result, the nostril wings appeared relatively emphasized from the front.

In such cases,

rather than reducing the alar base,

👉 the nasal tip must first be erected properly

so that the proportions of the nostril wings naturally align as well.

Surgical Plan and Actual Procedure Details

Thorough preoperative explanation

The nasal tip cannot be excessively raised

Rather than a dramatic structural change,

a surgery focused on improving proportions is necessary

Pre-guidance on the recovery period and the timing of tape and internal nasal packing removal

Actual Surgical Details

Performed under conscious sedation (twilight anesthesia)

Realignment of the nasal tip structure

Securing central support using septal cartilage

Refining the nasal tip shape using ear cartilage

Removal of unnecessary tissue

Correction aimed at softening the appearance of a long nose

Upward adjustment of the columellar skin that appeared droopy

Alar reduction was intentionally not performed.

Image Points (Post-operative changes)

[Front and side photos at 1–2 months post-operation]

The nasolabial angle opens up naturally as the nasal tip support is restored

Completion of a smooth curve connecting the nasal bridge → nasal tip → philtrum

Even without reducing the alar base,

The frontal appearance looks much more refined

Dr. Kim Sung-hoon's Surgical Insights

Alar reduction is by no means a simple or minor procedure.

In particular, if only the nostrils are reduced while the nasal tip structure is collapsed,

The overall proportions can become even more awkward.

In this patient's case, the alar base was not the issue;

Nasal tip support and the nasolabial angle were the core factors.

Rather than surgery that simply makes the nose smaller,

I prioritize surgery that establishes the central foundation properly.

When the nasal tip is stabilized, the alar base looks sufficiently neat even without aggressive alteration.

This is the most natural and long-lasting approach.

FAQ

Q1. I only wanted an alar reduction; do I really have to do the nasal tip as well?

A. Depending on the nasal tip structure, alar reduction can actually have the opposite effect.

Q2. How long does the recovery period take?

A. External taping can be covered with a mask, and the intranasal packing and ear tape are removed the next day.

Q3. Does this raise the nasal tip significantly?

A. This case aimed for "support and proportion" rather than "height."

Q4. Why is the nasolabial angle important?

A. The nasolabial angle is a key angle that simultaneously determines the impression of both the nose and mouth.

Q5. Can alar reduction be done later?

A. If necessary, it can be considered in stages.

Q6. How should I consult for this type of nose?

A. Structural analysis should be performed first based on frontal and profile photos.

Conclusion

At SH Plastic Surgery,

Rather than "the surgery you want to get,"

we tell you "the surgery you should not get" first.

Like this patient,

Even if you came in considering alar reduction,

if the tip of your nose actually takes priority,

correcting that order

leads to the most natural and safest results.

SH Plastic Surgery Clinic

Is non-surgical #alar reduction possible?