When a patient consults with us about a "nose bulge," we sometimes do not suggest a nasal wing reduction.
In this issue, we will explain the reasons for this.

When to suggest nasal wing reduction and when not to

I am not assuming that nasal wing reduction is not the first thing to be done.

If the nose is the only negative point, nasal wing reduction is the first-choice treatment.
If a person has a less rounded nasal tip, it is acceptable to perform nasal wing reduction from the beginning.

So what happens when a person with a rounded nasal tip undergoes nasal wing reduction only?

The nasal wings are reduced in size, but the roundness of the nasal tip is conversely emphasized.

In cases with a rounded nasal tip, it is recommended that the surgery to adjust the nasal tip be performed first, rather than performing a nasal wing reduction.

If the tip of the nose is thinned first, there is no need to worry that the roundness of the nose tip will be accentuated if a nasal wing reduction is performed later. Even more pleasantly, a higher nose tip will elongate the bulge of the nose and change its appearance.

Case Studies

Here is a case study of an actual monitored patient.

In both cases, nasal apex plication + auricular cartilage grafting were performed on the tip of the nose.

In the lower after photo, the patient tends to smile more and the nose tends to widen more, but the bulge of the nose is not noticeable. The width of the nose itself has not changed, but the appearance of the nose has changed because the tip of the nose has become narrower and higher.

The lower after photo shows a thinner nose tip, which appears to decrease the bulge of the nose from the front.

How was it?
In my previous column on the nose, I told you that the tip of the nose is the main part of the nose, and I hope this conveys the importance of the change in the tip of the nose.

There are quite a few cases in which people who complain of a rounded nasal tip and a bulging nose do not care about the nose after nose tip surgery and do not wish to have a reduction of the nasal wings.

Why we do not recommend nasal wing reduction easily

There are other reasons why I do not readily recommend nasal wing reduction.

The thing is that nasal wing reduction is a one-way surgery that cannot be reversed because the tissue is removed.

Compared to other nose surgeries, nasal wing reduction is a scarring surgery, and we would not recommend it unless the advantages gained outweigh the disadvantages of the scar.

We believe that nasal wing reduction is a finishing operation, so to speak, and if there are points to be improved in the nasal bridge or tip of the nose, it is better to give priority to those points.

The surgery of the nasal wings from the beginning is not a good idea.

The nasal tip is not rounded and only the nose is a negative point.
Obviously, the width of the nose is wide (nasal floor is wide).
Improvement of balance can be expected by resection of the nostril margin and elevation of the nasal wings.

This is limited to cases such as

Patient: "I am concerned about my nose and would like to have a nasal wing reduction."

Doctor: "Okay. Let's do a nasal wing reduction."

Then, you are no different than a clerk at a concession stand.

I believe it is my duty as a cosmetic surgeon to listen to the patient's wishes and then suggest the most appropriate treatment as needed.

Deputy Director: Hiroki Kuroda

#Dr. K's In-Depth Commentary Series