Bulbous Nose Correction with Alar Reduction — Even the Protruding-Mouth Look Improved: A Case Done with Ear Cartilage
2025. 5. 22.
A case where a bulbous nose with a sunken bridge that made the mouth look protruding was corrected with ear cartilage grafting and alar reduction (lower + inner incision) — no implant. Covers how incision sites are chosen and scar care.
Key points
- When the bridge is sunken it can give a protruding-mouth impression, so slightly raising the bridge is sometimes reviewed together in bulbous nose correction.
- This case proceeded with ear cartilage grafting and no implant — a reference case for those hesitant about rib cartilage grafting.
- Alar reduction was done with lower + inner incisions, and which area to incise is judged directly by the operating surgeon based on nostril shape and width.
There is a case where correcting a bulbous nose with somewhat prominent nostrils also changed what had looked like a protruding mouth. This patient wanted a natural nose with less presence while the line was being refined.
Through that case, this article organizes why bulbous nose correction looks at the bridge and alae together — and the criteria for choosing alar-reduction incision sites.
01
It's a bulbous nose — why did the mouth look protruding?
This case's preoperative state was a sunken bridge that created a protruding-mouth impression.
Even when the mouth itself doesn't protrude, a low bridge can make the mouth area look relatively prominent. So to change the overall impression, we proceeded with slightly raising the bridge — and as the bulbous nose improved, we gained the effect of the protruding mouth looking recessed.
02
How was it done without an implant?
This case proceeded with ear cartilage grafting and no implant.
- It was finished simply within the range ear cartilage grafting allows — with no implant, concerns about side effects like inflammation are also lower.
- A case worth referencing for those hesitant about rib cartilage grafting.
When implant-free surgery is possible is covered in more detail in the implant-free rhinoplasty guide.
03
Where was the alar reduction incised?
Alar reduction in this case was done with lower + inner incisions.
| Factor checked | Details |
|---|---|
| Incision-site decision | The operating surgeon judges directly which area to incise, based on nostril shape and width |
| Incisions in this case | Lower + inner incision |
| Scar | May look prominent right after surgery, but becomes sufficiently unnoticeable through care after stitch removal |
Right after alar reduction the scar can look prominent, but after stitch removal it goes through a process of becoming unnoticeable with care. This case's before-and-after changes can be seen in the before-and-after photos.
04
Summary — look beyond the alae to the bridge
What this case shows is that bulbous nose correction isn't only a matter of the tip and alae. A sunken bridge can extend into a protruding-mouth impression, so the correction direction was set by viewing the whole line including the bridge. For materials too, if rib cartilage feels burdensome, checking whether your case falls within the range ear cartilage grafting allows is a good start.
If you're curious which category your nose falls into, it can be checked in a 1:1 video consultation.
Frequently asked questions
Answers to common questions patients ask before a consultation.
Does correcting a bulbous nose also improve a protruding mouth?
Can bulbous rhinoplasty be done without rib cartilage?
Does the alar-reduction scar remain forever?
Responses to treatment and recovery progress vary by individual. Outcomes and side effects vary from person to person. Bleeding, infection, swelling and asymmetry may occur. Please consult our medical team before making a decision.