Abnormal nose shape

Disease Description (Causes and Symptoms)

• Definition: A cosmetically unsatisfactory nose shape, such as a low nasal height, a depressed or excessively protruding nasal column (nasal dorsum), including a flat nose, saddle nose, or hump nose.
• Causes/Pathophysiology:
  • Congenital (genetic) differences in cartilage and skeletal development.
  • Trauma (depression or deformity due to fracture) or deformity caused by previous surgery.
  • Cartilage resorption or tissue atrophy (loss of autologous tissue, complications from foreign materials, etc.).
  • Imbalance with the individual's facial skeletal structure (forehead–nose–chin proportions).
• Main symptoms:
  • Cosmetic concerns (the nose appears low, a hump on the nasal dorsum, broad alae, etc.).
  • Functional symptoms such as difficulty breathing, nasal congestion, or a deviated nasal septum may also occur in some cases.
• Diagnosis (evaluation):
  • Clinical examination (frontal, lateral, and inferior-view photographs), with evaluation of the nasal structures (cartilage and skeleton) and skin condition.
  • Functional evaluation (nasal breathing and septal condition). If necessary, nasal endoscopy and CT may be performed to assess structural problems or confirm a history of surgery.
  • Detailed discussion of the patient's expectations and cosmetic goals (using photographs and simulation).

Treatment Methods and Precautions

• Nonsurgical procedures:
  • Fillers (such as hyaluronic acid) for temporary correction of the nasal bridge — simple, but with limited duration; caution is required regarding foreign-body reactions and vascular complications.
• Surgical treatment (main options):
  • Augmentation rhinoplasty: surgery to raise the nasal bridge
    • Grafts/implants: autologous cartilage (ear cartilage, septal cartilage, or costal cartilage), acellular dermis, or synthetic implants (such as silicone).
    • Advantages/disadvantages: Autologous cartilage has a low risk of graft rejection and infection (although scarring or pain at the harvest site may occur). Synthetic implants are easy to shape, but there is a risk of extrusion and infection.
  • Tip plasty: Improvement of the shape through suturing or grafting of the tip cartilage.
  • Hump nose correction (hump removal and osteoplasty): Removal of the central hump and, when necessary, adjustment of the nasal bridge width through osteotomy.
  • Alar base reduction: Surgery to reduce the width of the nostrils.
  • Surgical approach: Either an intranasal, closed approach or an open approach involving an incision in the columella may be selected.
  • Anesthesia: Local anesthesia with sedation or general anesthesia.
• Postoperative care and precautions:
  • Swelling and bruising are usually most severe 2–3 days after surgery and may last up to 2–3 weeks; final changes gradually develop over several months, up to 6–12 months.
  • Apply cold compresses initially and monitor for signs of bleeding or infection.
  • Gauze or packing inside the nose is usually removed after 3–4 days. External tape or a splint is usually kept in place for 5–7 days.
  • Suture removal: approximately 5–7 days, depending on the surgical method.
  • Limitation on wearing glasses: approximately 1 month is recommended to avoid applying pressure to the nose.
  • Vigorous exercise and heavy activities should be restricted for several weeks.
  • Scarring: An open procedure may leave a columellar scar, but it is usually in a location that is not readily noticeable.
• Complications (points of caution):
  • Bleeding, infection, hematoma, and skin necrosis (rare).
  • Implant extrusion, displacement, infection, or skin irritation.
  • Resorption or warping of autologous cartilage (costal cartilage, in particular, may deform over time).
  • Breathing problems (nasal narrowing or septal problems), decreased sensation, and the need for revision surgery due to cosmetic dissatisfaction.
• Preventive measures:
  • Smoking cessation is recommended before surgery (to reduce the risks of impaired wound healing and infection).
  • Discontinue anticoagulants and NSAIDs for a specified period as directed by the doctor.
  • Have a thorough consultation and establish a surgical plan with an experienced board-certified plastic surgeon.

Outpatient Visit Checklist (Including Preparation Items and Sample Questions)

• Items to prepare/bring:
  • A list of current medications (prescription drugs, OTC medications, anticoagulants, herbal products, etc.).
  • Past medical history and surgical records (especially previous nasal surgery or trauma).
  • Allergy history (medications, anesthesia, anaphylaxis, etc.).
  • Smoking status and alcohol-use habits.
  • Recent photographs (frontal, lateral, and butterfly/inferior views, etc.; images the patient prefers may also be brought).
  • Example photographs showing the desired outcome (for reference).
  • Previous test results, if available (such as CT scans or endoscopy findings).
• Information to tell the medical staff in advance during the outpatient visit:
  • Underlying conditions that increase surgical risk, such as bleeding disorders, anticoagulant use, diabetes, or immunosuppression.
  • Psychological expectations (whether expectations are realistic).
• Sample questions before the consultation (useful for patients to prepare themselves):
  • Is surgery impossible because of the medications I am currently taking, especially those related to blood clotting?
  • Which surgical method is most suitable for my facial structure?
  • Can I see before-and-after photographs?

General Sample Questions to Ask the Doctor

• Regarding surgery
  • What surgery do I need in my case (augmentation rhinoplasty, tip plasty, hump removal, etc.)?
  • Which approach is suitable, open or closed? What are the advantages and disadvantages?
  • How will anesthesia be administered? Is general anesthesia necessary?
• Regarding materials and complications
  • What are the advantages and disadvantages of autologous cartilage and silicone implants? Why do you recommend one for me?
  • What is the likelihood of surgical complications (such as infection or implant extrusion), and how would they be managed?
• Regarding recovery and prognosis
  • How long is the recovery period, and when can I return to daily activities?
  • When can I expect to see the final result (after the swelling has subsided, etc.)?

Examples of Personalized Questions by Condition

• “My nasal dorsum has a hump, and my nasal tip droops. Do I need combined surgery consisting of hump removal and raising the nasal bridge (augmentation rhinoplasty)? If so, which graft material would you recommend?”
• “I want a natural and long-lasting result. Is it possible to use autologous cartilage (ear, septal, or costal cartilage) in my case? How high is the risk of long-term resorption or deformity?”

Additional guidance: Because individual outcomes and risks vary with every surgery, please undergo a detailed examination and thorough consultation before the procedure—including the expected results, complications, alternative options, costs, and possibility of revision surgery—before making a decision.