Alar Reduction and Nasal Bone Narrowing in Seoul: Which One Does a Wide Nose Need?

Why does a nose look wide?

Many people describe the same concern, "my nose looks wide from the front," but the width can start in different places:

• The nasal bones that form the upper part of the bridge may be broad.
• After a hump has been removed, the two bones may have been left apart.
• The nostril wings (alae) may flare outward, or the base where they meet the face may itself be wide.
• In some noses the lower part looks broad because the tip cartilage and skin are thick.

Where a nose can look wide from the front

Replay

1. 1Nasal bonesthe upper bridge — may be broad or uneven
2. 2Open roofbones left apart after a hump was removed
3. 3Alaethe nostril wings bulge outward
4. 4Alar basewhere the alae meet the face — compared with the inner eye-corner distance
5. 5Tipthick cartilage and skin — assessed separately as tip surgery

Each cause calls for a different fix, so the starting point is to work out where the width comes from.

Even "wide nasal bones" is not a single problem. One study set out a step-by-step plan for osteotomies (controlled cuts that move the nasal bones). It stresses the difference between a broad dorsum, the top of the bridge, and a broad bony base, where the bones meet the cheeks. It treated 53 patients in three groups:¹

• A broad base: lateral osteotomies only
• A broad base and dorsum: lateral and medial oblique osteotomies
• A broad dorsum alone: medial oblique osteotomies only

Reading the width from the front

What you see points to where the width usually comes from, and to what is checked at the clinic.

If you see this

• 1A broad, flat bridge below the brows

  Bone width, thickness and asymmetry are checked; osteotomy is considered

  Bone narrowing

• 2A bridge that widened after hump removal

  The earlier removal and bone position are checked; osteotomy to close the gap is considered

  Open roof

• 3Nostril wings that bulge outward

  Alar thickness and flare on smiling are checked; alar reduction is considered

  Alar reduction

• 4A wide alar base and nostril floor

  The ratio to the inner eye-corner distance and nostril shape are checked

  Alar base

If the lower nose looks broad and bulbous, the tip cartilage and skin may be the cause. Then the tip cartilage shape and skin thickness are checked, and it is assessed separately as described in the nose tip surgery guide.

What are nasal bone width and the "open roof"?

The two nasal bones meet at the top of the bridge like a roof. Removing a hump cuts off the peak of this roof. It can leave a flat gap between the bones, known as an open roof. Left open, the bridge looks wide and flat. That is why osteotomies to move the bones inward are often planned together with hump removal. If the hump itself is your main concern, our guide to hump nose surgery covers it in detail.

When the bones are left apart after hump removal

Replay

1. 1Bones meet like a roofthe two nasal bones meet at the top of the bridge
2. 2After hump removalthe peak is cut off and the bones are left apart
3. 3Osteotomy linesbone is cut at the base and near the top
4. 4Moved inwardthe bones come together and the roof closes

A common problem with osteotomies is that the width of the dorsum does not narrow as much as hoped. In a study that combined anatomical research on 9 cases with the treatment of 53 patients, a medial oblique osteotomy placed on the outer side of the peak of the open roof narrowed the dorsum most. A lateral osteotomy was not needed to reduce dorsal width alone. After 15 to 32 months, bone width was satisfactory in all but 3 of the 53 patients, one of whom had revision surgery.¹ Which cut is made, and where, therefore shapes how much narrowing is possible.

You may hear that East Asian nasal bones are short and wide. But a CT comparison (X-ray images that show cross-sections) of 64 Korean and 27 white adults found something different. The bridge and its cartilage part were longer in the white group. But there was no significant difference in nasal bone length, nasal height, tip projection or septal area (the septum is the wall dividing the inside of the nose).² Rather than relying on generalizations by ethnicity, the length, width and thickness of each person's nasal bones need to be checked directly.

How can the nostrils look wide?

Wide-looking nostrils also come in two forms:

• The alae bulge outward (alar flare).
• The base where the alae attach, and the nostril floor, are wide.

Often both are present. Alar width is commonly compared with the distance between the inner corners of the eyes (intercanthal distance).³

A systematic review (a study that gathers all relevant research by a set method) covered 22 studies on nostril surgery (1,599 patients). Excision (cutting away a small piece) was used in 45.5%, cinching sutures that draw the alar bases together in 40%, and combinations in the rest. For excessive flaring, alar wedge resection (removing a small wedge) was chosen in 92% of cases. For a wide base, the method depended on the other features present. In 795 of the 1,599 patients, nostril surgery was done at the same time as rhinoplasty.⁴

The nose from below: ways to narrow the alae

Replay

1. 1The nose from belowflaring alae, or a wide alar base and nostrils
2. 2Alar wedge excisiona small wedge is removed at the crease where the ala meets the cheek
3. 3Nostril sill excisiona little of the nostril floor is removed to narrow the base
4. 4Cinch suturethe two alar bases are drawn together with a suture, without excision

A study at a university hospital in Korea looked at 73 patients who had combined nostril sill and alar excision. The ratio of alar width to intercanthal distance fell on average from 1.07 to 1.04. Of 60 patients with flaring, 45 (75%) no longer had it afterward, and horizontally shaped nostrils fell from 29% to 3%. Complications occurred in 4 patients: one alar deformity, one under-corrected asymmetry and two under-corrected flares.³ Results were generally good. But a change from 1.07 to 1.04 also shows how small, and how fine, these adjustments are.

How is the approach chosen?

It helps to see where the work is done. The nasal bones are cut and moved; the alae are narrowed by removing a little skin or drawing them together with sutures.

Which osteotomy, and where (example)

Replay

1. 1A broad baselateral osteotomy, cutting where the bones meet the cheek
2. 2A broad dorsummedial oblique osteotomy, angled up and out from mid-bridge
3. 3Both broadboth osteotomies, then the bones are moved inward
4. 4The alaea little is removed at the alar crease or the nostril floor

Here is how the methods compare:

Method	Suits	Good to know
Lateral osteotomy	Broad bony base	May not narrow the dorsum enough
Medial oblique osteotomy	Broad dorsum	Narrowing depends on placement
Medial and lateral	Broad dorsum and base, open roof	Wider cuts, careful planning
Alar wedge excision	Outward flare	Scar in the alar–cheek crease
Nostril sill excision	Wide base and nostrils	Too much can distort nostril shape
Cinching suture	Narrowing the base without excision	Sometimes combined with excision

In short, width in the upper bridge changes only when the bones are moved, and width at the nostrils changes only when the alae are addressed. Narrowing the bones while leaving wide alae can upset the balance between top and bottom. Narrowing only the alae can make the bridge look relatively wide. Whether to do one or both is decided by looking at bridge width, alar width and the tip together.

What should I expect during recovery?

At Bonita Clinic, we perform alar reduction and nasal bone narrowing as surgery under sedation combined with local anesthesia; you go home the same day, and stitches are used. How long recovery takes and how often you need to come back depend on how much is done and on your own healing.

• Swelling and bruising around the eyes: after nasal bone osteotomies, eyelid swelling and bruising around the eyes are common. A meta-analysis (a study that pools the results of many studies) compared osteotomy techniques. As the main early effects, it measured eyelid swelling, bruising around the eyes and pain within the first 3 days and on day 7. Their severity differed between techniques.⁵
• Breathing: lateral osteotomies can narrow the internal nasal valve, the narrowest part of the nasal airway. A study measured 30 patients before and 6 weeks after surgery. The valve area decreased in every patient after lateral osteotomy, with no difference between the two techniques compared.⁶ If your nose is already blocked, mention it before surgery.
• Scars: alar wedge excision leaves an incision in the crease where the ala meets the cheek; nostril sill excision leaves one inside the nostril floor. In the Korean study above, alar deformity and under-correction of asymmetry or flare occurred in a few patients.³
• Residual width and asymmetry: the bones may not come together fully, or some difference between sides may remain. In the osteotomy study above, 3 of 53 patients were not satisfied with bone width and one had revision surgery.¹
• Any surgery, whatever the method, can cause swelling, bleeding, inflammation, infection or nerve injury, and recovery and results differ from person to person.

How we approach it at Bonita Clinic

The actual surgical plan is decided after an in-person consultation.

Treatment options you can discuss in Seoul

Since opening in 1995, Bonita Clinic has stayed at the same location, where Dr. Kwang-Seop Chung, certified as a plastic surgeon in Brazil, sees patients himself. For a wide-looking nose, the options described on our treatment page are:

• Nasal bone narrowing (osteotomy), with medial and lateral cuts planned together and matched to any hump removal
• Alar reduction, with the bridge width set in proportion to the alae and tip
• Analysis of bone width and asymmetry, bridge-to-alar ratio, skin and bone thickness before planning
• Recovery care focused on tissue stabilization, fixation, swelling and left–right balance

Which of these you need, and whether they are combined with other nose surgery, is decided only after an examination. Surgery that addresses the bridge, tip and alae together is described on our Full Rhinoplasty page.

Why do the plan and cost differ from person to person?

"Make my nose narrower" can mean very different operations. The plan and the cost depend on where the width comes from and how many parts need to be addressed.

• Which part is wide: bones, open roof, alae, alar base
• Osteotomy, alar reduction, or both
• Hump removal or other nose surgery at the same time
• Previous nose surgery and scarring
• Asymmetry or breathing problems to address
• Anesthesia: sedation with local

Final plan and quote after an in-person exam

A final estimate is given only after an in-person examination, once it is clear which parts need surgery. Photos can point to a likely direction, but the scope is only set in person.

What can photos show, and what needs an in-person exam?

Width is easy to see in photos, which makes them a good starting point. Bone thickness, earlier surgical changes and the airway are not.

Photos can show

• Bridge width from the front
• Alar width and flare
• Nostril shape from below
• Visible asymmetry
• Flare when smiling

Needs an in-person exam

• Nasal bone width and thickness
• Gaps or steps from earlier surgery
• Alar thickness and skin
• Internal valve, septum, breathing
• Which osteotomy fits

Helpful photos: front, both 45-degree views, both profiles and a view from below showing the nostrils, in even light and without contouring makeup. If you have had a hump removed before, photos from before that surgery help. You can send us a message with your photos and a note on which part looks wide to you.

Planning your visit and recovery

What is confirmed in advance is the treatment information above: surgery under sedation with local anesthesia, same-day discharge, and stitches. How long you should stay in Seoul, when the stitches come out and how many follow-up visits you need depend on whether osteotomy, alar reduction or both are done. These are planned together with you at consultation.

Because bruising and swelling around the eyes are common after osteotomies,⁵ it is sensible to keep the early days after surgery free of important events and photos. Alar incisions have stitches, and how their removal fits your trip is part of the planning conversation. After you return home, contact a doctor promptly if pain, redness, swelling, bleeding or a blocked nose gets worse instead of settling. Dated front and below-view photos make it easier for any doctor to follow your progress.

Real treatment cases

These cases are from our alar reduction and nasal bone narrowing page. Results vary from person to person.

Bridge and alae seen from the front

Bridge and alae seen from an angle

* Results vary from person to person. Side effects are possible, so please decide after a thorough consultation with a doctor.

Frequently asked questions

My bridge is wide. Can't the skin on top just be thinned?

When the width comes from the nasal bones, thinning the skin and soft tissue (the soft layers under the skin) rarely changes it. Osteotomy to move the bones is considered instead. Whether the dorsum or the bony base is wide changes which osteotomy fits, so this is distinguished at examination.¹

Will osteotomy leave a step or bumps?

A lateral osteotomy alone can leave the bones incompletely closed or leave a step. That is why the medial and lateral cuts are planned together. Whether any difference between sides remains is checked as the swelling settles.

Will the alar reduction scar be visible?

Alar wedge excision leaves a line in the crease where the ala meets the cheek, and nostril sill excision leaves one inside the nostril. Both sites tend to be less noticeable, but a scar can remain, and it is managed so that it fades over time.

Will narrowing the nasal bones affect my breathing?

Lateral osteotomies have been shown to narrow the internal nasal valve.⁶ If you already have a blocked nose or a deviated septum, breathing is checked before surgery and taken into account in the plan.

Can this be done together with hump surgery?

Yes. Removing a hump often leaves the bones apart, so osteotomies are commonly planned in the same operation, matched to the amount of hump removed. Surgery that addresses the bridge, tip and alae together is covered in our full rhinoplasty guide.

What to prepare before your consultation

• Front, 45-degree, profile and from-below photos
• Which part looks wide to you: the upper bridge, the alae or the tip
• Any previous nose surgery, especially hump removal, with approximate dates
• Breathing problems such as a blocked nose, rhinitis or snoring
• Dates when visible bruising around the eyes would be a problem for you

Bonita Clinic is on the 3rd floor of 565 Gangnam-daero, Seocho-gu, Seoul, about 100 m on foot from Exit 8 of Nonhyeon Station (Line 7). You can read more on our Alar Reduction & Nasal Bone Narrowing page. If the lower nose looks bulbous, see Nasal Tip Rhinoplasty and the nose tip surgery guide.