Why Are Alar Reduction and Cartilage Tying Done Together? — Criteria Seen Through a Case Correcting a Bulbous and Deviated Nose at Once

01

What was the state, and why was a combination needed?

This case showed a spread-looking bulbous shape together with a bridge tilted to one side — featuring overall asymmetry plus a tip that looked wide and dull. In this kind of structure, rather than simple height adjustment, a process of straightening the center and balancing tip and bridge at the same time matters.

Photos taken from below confirmed tip cartilage spread with the nostrils opened sideways as if lying down, and from the front, though the bridge was low and not very prominent, the septum was observed shifted to one side — a mild deviated-septum shape. In such cases, adjusting it together during surgery is needed. When the bridge is low it isn't very visible, but once height is created the bent part can stand out more.

There was also a history of a prior thread-based nose procedure, so the direction was set to clear the residual threads while proceeding as revision surgery, raising structural stability.

02

How was the surgery composed?

Because the patient wanted a natural change, the plan was to tidy the tip with cartilage tying while gently supplementing height. The composition organized looks like this.

The goal was to finely adjust the tip's volume and left-right balance and align the bridge line to the face's center line, creating a stable flow in both front and side views. In this process, the columella (nasal pillar), the nasolabial angle (the angle formed by the nose and upper lip), and the philtrum line's connection were also considered so the tip would settle naturally at center. What is checked in tip correction can be seen in more detail in the nasal tip surgery guide.

Right after surgery is a stage before swelling fully forms, so the bridge and tip lines and the overall structure can be checked relatively clearly. Structural change appears distinctly early on, then gradually settles into a softer form during recovery. In the front comparison, the previously wide-looking nose shape was confirmed tidied into a slimmer impression. Actual correction cases can be seen in the before-and-after photos.

03

Does a bulbous nose always require alar reduction?

Generally, many think alar reduction must always be done to improve a bulbous nose — but depending on the situation, cases improve sufficiently with tip cartilage tying alone. Alar reduction was combined in this case because not only the tip cartilage but the nostrils themselves were spread wide left and right.

Some worry that alar reduction will make the smiling expression awkward or leave traces around the nostrils — but besides the incision method there is a non-incision method that reduces the burden. Even when an incision method is chosen, depending on the design many cases finish naturally, so there is no need to worry excessively.

04

Summary — structural confirmation comes before height

When a bulbous nose and deviation exist together, touching just one thing makes it hard for the whole impression to settle. This case combined tip cartilage tying to gather the spread cartilage, non-incision alar reduction to narrow the width, and straightening the shifted bridge center. Still, even for the same bulbous nose, whether alar reduction is needed or cartilage tying alone suffices differs per person. If you wonder which applies to your nose, the structure can be confirmed in a 1:1 video consultation.