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   OZ (2015-02-06 15:01:49, Hit : 11209, Vote : 135)
   Nasal Narrowing
Nasal Narrowing.

Most people don’t like wide nose because it may look mean.
Wide nose has many meanings because nose is a complicated structure.
Nose is composed of Nasal bone, middle vault(upper lateral cartilage), nasal tip(lower lateral cartilage), and nasal alar.
Each part can be approached according to the patient.

1. Wide nasal bone
If the patient has wide nasal bone, the bone should be narrowed with osteotomy.
Both lateral wall of nasal bone should be broken and be moved to the midline.

(Nasal osteotomy to make nasal bone narrower)

(nasal bone narrowing with hump removal to make the wide nasal bone narrower without inserting nasal implant. The tip was also narrowed with nasal tip cartilage modification.)

(nasal bone narrowing without inserting nasal implant together with nasal tip narrowing and augmentation with septal cartilage graft for maximal nasal tip projection. Notice the middle vault narrowing that was caused by nasal bone narrowing.)

2. Wide middle vault
Upper lateral cartilages of nose are attached to nasal bone and become narrower when nasal bone is narrowed.

3. Wide nasal tip
Asians usually have thick nasal tip skin, weak & small nasal tip cartilages, insufficient nasal tip projection.
So, nasal tip augmentation and narrowing has utmost importance.
Attempts to make nasal tip augmented and narrowed by implant in the past produced many dreary complications and is no longer used nowadays in modern plastic surgery.
(This caused improper fear and misunderstanding about nasal implant and became the main cause of attempts to avoid nasal implant to the uneducated patients. But nasal implant at bridge is one of the safest and the most effective method for nasal bridge augmentation still.)

Flared nasal tip cartilages and insufficient projection of nasal tip are the most common causes of wide nasal tip.
Nasal tip augmentation and modification of nasal tip cartilages can make the nasal tip look smaller, narrower, and pointier.

1) Septal cartilage graft
To the patients who have insufficient support of nasal tip, septal cartilage should be grafted between nasal tip cartilages so that it can support nasal tip.
Otherwise, synthetic material like Medpore can be grafted instead of septal cartilage when the patient doesn’t have enough septal cartilage (due to previous surgery) or rib cartilage can be used also.
Even if rib cartilage is strong enough, it is much more risky, complex, and expensive procedures. So, septal cartilage graft is always preferred over rib cartilage graft.

(Harvested septal cartilage from inside of nose is grafted at the end of remained septal cartilage to make nasal tip longer and augmented)

(Another way of septal cartilage graft. A strip of septal cartilage is grafted between nasal tip cartilages to support nasal tip and augmented.)

(nasal tip augmentation & elongation using septal cartilage graft. Nasal bridge is augmented also to make the nose look longer.)

2) Nasal tip cartilage modification with or without ear cartilage graft

To the patients who have strong nasal tip cartilages with flared nasal tip cartilages, modification of nasal tip cartilages’ shape and position with or without ear cartilage graft can make the tip look smaller without any graft of cartilages.
Ear cartilage is grafted on top of nasal tip cartilages to make the nasal tip more defined and slightly augmented.

(Modification of nasal tip cartilages position and shape by nasal tip cartilage work)

(nasal tip augmentation using nasal tip cartilage modification and ear cartilage graft)

(nasal tip narrowing and shortening by nasal tip cartilage modification only. Notice the cephalic rotation of nasal tip for younger and feminine impression. Notice the asymmetry correction also in worm’s eye view.)

3) Too big nasal tip cartilage
If the patient has big nasal tip cartilages like Caucasian nose, part of it can be removed or grafted on nasal tip.

(Nasal tip debulking by removing the part of nasal tip cartilages)

(nasal tip narrowing, shortening, lowering, and debulking by nasal tip cartilage modification with removing the part of too big nasal tip cartilages)

4) Fatty nasal tip
To the patients who have bulky soft tissue in nasal tip, removing the excess soft tissue should be done together with nasal tip augmentation to make the tip more defined.

(nasal tip augmentation and debulking by nasal tip cartilage modification, ear cartilage graft, and soft tissue debulking)

4. Wide nasal alar
Wide of flared nasal alar needs alar reduction.

But most Asian patients who want to undergo nasal alar reduction have insufficient nasal tip projection and wide nasal alar together.
So, nasal alar reduction alone is insufficient in most of cases and nasal alar reduction together with nasal tip augmentation always shows better result and can make them satisfied.
Sometimes, nasal tip augmentation alone (without nasal alar reduction) can make the nasal alar narrower.

(nasal tip augmentation with alar reduction make the nose look much narrower and smarter)

5. Wide looking nose
When the patient has flat nose, the nose looks wide even if the patient doesn’t have wide nasal bone.
In this case, nasal bridge augmentation with implant insertion (without nasal bone narrowing) can make the nose look narrower easily.

(nasal bridge augmentation with implant insertion, nasal tip augmentation with Medpore implant and ear cartilage graft. Notice the narrower looking nasal bridge with implant insertion.)

There are many methods in nasal narrowing.
According to your nose, appropriate method will be recommended.

Hyuncheol Park MD
OZ Cosmetic Clinic


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