RIGHT-AFTER CASE BRIEFING
Male rhinoplasty: a large, bulbous nose reduced to suit the face — immediately after surgery
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.
These KOWON Plastic Surgery male rhinoplasty before-and-after photos, taken right after surgery, show the actual direction of change as a nose that looked large and spread was brought into proportion with the face.
Hello, this is Dr. Kim Hyung-taek of KOWON Plastic Surgery.
At consultation this patient described three concerns: that his nose was large overall and bulbous, that the tip spread a lot when he smiled, and that he wanted his philtrum to look natural after surgery as well. Like many male patients, his first priority was not a conspicuously higher nose but getting rid of the large, heavy look.
From the side, the bridge was wide and the dorsum prominent, and the tip, with thick soft tissue, drooped and was bunched into a round shape.
The alae also flared sideways, so from the front the nose seemed to take up a large part of the centre of the face.
How much can a large, bulbous nose be reduced?
There is something I told him frankly first: there is a limit to how much a large, bulbous nose can be reduced. A tip looks big because of two things together — splayed cartilage and the thick tissue covering it. The cartilage can be brought together, but skin thickness is something each person is born with, and it cannot be made fully thin. Removing too much tissue can instead leave the tip bumpy or cause skin problems.
So rather than fixating on making the tip small, I recommended tidying the bridge and alae together so that the nose as a whole looks smaller within the face. What I have seen over more than 20 years of male rhinoplasty is that, with a large nose, refining several areas a little each tends to look more natural, and sit better with patients, than reducing one area a lot.
Why does the tip spread when smiling?
The tip spreads when smiling because the tip cartilages are splayed apart and the smiling muscles pull the tip sideways and down. Bringing the tip cartilages together toward the centre and holding the tip with septal cartilage so it isn’t pulled down can noticeably reduce how far it spreads when smiling. Because he wanted his philtrum to look natural, I set the tip moderately forward so that the angle where the tip meets the philtrum wouldn’t look forcibly lifted.
How this patient’s surgery was done
At the tip, I removed the soft tissue that had made it thick, within safe limits, and brought the splayed cartilages together toward the centre. Supporting the tip with septal cartilage so it doesn’t droop also addressed the spreading when smiling.
I also did a hanging-columella correction. In many men the central pillar under the tip hangs down, so the nostrils look stretched from the side; tidying this area makes the tip look lighter and neater.
The wide, angular bridge was narrowed with an osteotomy, bringing the nasal bones inward. On the bridge I placed a custom silicone implant carved to fit this patient’s nose; its role was less to add height than to refine the line so that it runs smoothly in one line from the glabella to the tip over the narrowed dorsum. In a man’s nose, a conspicuously higher bridge immediately looks awkward, so I kept the height as natural as possible and designed the custom silicone separately so that it continues up to the glabella with a natural, masculine feel.
Finally, the flared alae were reduced with an incisional alar reduction. If the tip is refined and the bridge narrowed but the alae are left as they are, the nose still looks big from the front, so for a large nose like this, alar reduction is a step that shouldn’t be left out. Because it involves an incision, the scar on the alae is visible at this stage, but because the incision follows the alar crease, it gradually becomes less noticeable over six months to a year.
In the photo taken right after surgery, you can see that the bridge has become smooth and the drooping tip has been brought forward, making the profile line cleaner. The nose was not raised; it was reduced and brought together — and that is why the whole face looks tidier.
[OP PLAN]
- Diagnosis: large nose + bulbous nose, wide bridge, drooping tip, flared alae (male)
- Patient’s requests: improve the large, bulbous nose, reduce tip spreading when smiling, keep the philtrum natural
- Tip: tip soft-tissue removal + bringing the tip cartilages together + tip support with septal cartilage
- Columella: hanging-columella correction – tidying a drooping columella
- Bridge: osteotomy (narrowing the dorsum) + custom silicone – natural height, a straight line from the glabella to the tip
- Alae: incisional alar reduction
- Approach: open rhinoplasty (open incision)
See this patient’s before-and-after photos 2 months after surgery
Right after surgery is the stage before the swelling really builds, so the bridge and tip lines and the change in the overall size of the nose created by the rhinoplasty can be seen relatively clearly.
KOWON Plastic Surgery starts from natural-looking change, but aims beyond a result that simply doesn’t show — for a “natural-glam” rhinoplasty that brings out the flow of the line and its details.
As recovery goes on, the swelling subsides and the tissues settle, and the tip takes on a softer, more natural shape than it has now. Osteotomy and alar reduction can leave swelling and bruising a little longer than other rhinoplasty, but these settle with time. Rhinoplasty results can differ with each person’s skin thickness and cartilage, and the settled final result can be seen after a sufficient recovery period.