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Reduction Rhinoplasty

Reduction rhinoplasty is a surgical procedure designed to reshape and resize the nose, enhancing facial symmetry and harmony. The surgery refines nasal proportions by addressing concerns like excessive size or prominence.

Beyond aesthetics, it can also improve nasal function, providing both cosmetic and practical benefits.

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Dr Terence Goh

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Customisation in Reduction Rhinoplasty

This procedure offers tailored solutions to suit individual preferences and facial structures. Patients may choose to address specific concerns, such as reducing a prominent nasal hump, narrowing a wide nasal tip, or refining overall size. The focus is on achieving a balanced appearance while maintaining harmony with other facial features.

Image Reduction_rhinoplasty_anatomy Image Reduction_rhinoplasty_anatomy

Refining Nasal Proportions

  • Upper 1/3: The wide nasal bone can be narrowed using osteotomies (nasal fractures).
  • Middle 1/3: A nasal hump can be smoothed and reduced to enhance the side profile. Additionally, cartilage and the nasal septum may be modified to decrease the prominence of the nasal dorsum.
  • Lower 1/3: Tip-plasty can reshape or reduce the nasal tip for improved harmony, and nostril reduction (alar base reduction) may be performed if the alar bases appear wide.

Who Is a Candidate for Reduction Rhinoplasty?

This procedure may be suitable for individuals who:

  • Have a hump nose linked to ethnic or racial characteristics.
  • Have a hump nose resulting from a previous injury.
  • Feel their hump nose gives an overly strong or masculine appearance.
  • Wish to address functional issues, such as those caused by a deviated nose.
  • Seek improvements to both the profile and frontal views of their nose.

Reduction Rhinoplasty Techniques

Reduction rhinoplasty offers various approaches tailored to specific nasal features and individual preferences.

Hump Reduction

Cartilage and bone are reshaped or reduced to smooth a pronounced dorsal hump, resulting in a straighter nasal bridge and an improved profile.

Bridge Narrowing (Osteotomy)

This involves using osteotomies (controlled fractures of the nasal bones) to adjust the width of the nasal bridge, achieving greater symmetry and proportional alignment.

Tip Refinement

Sculpting techniques focus on reshaping the nasal tip to reduce bulbosity or prominence, helping create a more proportionate and defined appearance.

Alar Base Reduction

For individuals with wide or flared nostrils, this method reduces the base of the nostrils to complement the new nasal structure.

Functional and Structural Adjustments

Procedures such as septoplasty address issues like a deviated septum to improve breathing while enhancing the overall structure of the nose.

Complementary Techniques

Complementary techniques can be used to minimise the need for more invasive measures such as osteotomy (controlled bone fracturing).

  • 3D Printed Implants: Custom implants accommodate pre-existing irregularities, such as small bumps, and reduce the need for extensive bone reduction.
  • Glabella Augmentation: The nasal bridge can be subtly enhanced using finely diced cartilage, reducing the necessity for aggressive hump removal.
  • Tip Plasty for Drooped Tips: Specific methods elevate a drooped nasal tip to align it with the nasal bridge, enhancing the overall contour and appearance.

Approaches to Correcting Hump Nose Deformities

Different hump nose scenarios require tailored approaches to address unique anatomical features and aesthetic concerns.

reduction-dorsal-hump#1-low nasal

A hump nose combined with a flat forehead and low nasal tip is a common feature, particularly in Asian noses.If you have a hump nose along with these characteristics, the hump can be reduced by sanding (rasping) the nasal bone, and an osteotomy is generally not required.

The nasal dorsum can be smoothed using your own tissue, such as deep temporal fascia, or occasionally augmented with an implant or additional tissue. If increased nasal tip projection is needed, the tip can be enhanced through a tip-plasty, typically using your own cartilage. This approach creates a balanced and harmonious nasal profile.

reduction-hump#2-large nose

A hump nose combined with a large nose and a prominent nasal tip is a common characteristic, often seen in Caucasian patients. If you have these features, the hump will need to be reduced, along with the nasal tip.

Depending on the degree of size reduction required, the hump may be removed on its own, or the nasal bones may be osteotomised (fractured) to achieve further size reduction. The nasal tip will also be refined to create a balanced and harmonious relationship between the dorsum, tip, and overall facial features.

spreader_grafts-hump#3-deviated

A hump nose is often associated with a deviated or curved septum. Proper diagnosis before surgery is necessary to avoid complications such as a deviated nose or recurrence of the deformity.

The deviated septum needs to be excised, straightened, and reinforced. This is typically achieved using spreader grafts, which help rebuild the nasal structure on a stable foundation. Once the septum is corrected, a tip-plasty can be performed to refine the nasal tip and complete the overall reconstruction.

Total Reduction

When all components of the nose are disproportionately large, a total reduction combines techniques such as hump reduction, osteotomy, nasal septum adjustment, and tip and alar refinement. This comprehensive approach ensures the entire nasal structure is harmonised, creating balance and proportionality while maintaining functional integrity.

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Preparing for the Procedure

Consultation

A detailed evaluation of the nasal structure and facial proportions is conducted to create a personalised surgical plan. Specialised tools such as pre-operative 3D imaging and scans provide a clear visualisation of potential outcomes, ensuring alignment between the patient’s goals and realistic expectations. These scans also assist in planning customised 3D-printed implants, if needed.

Medical Evaluation

As part of the pre-operative process, overall health is assessed, including a review of previous surgeries, current medications, and any underlying medical conditions. This comprehensive evaluation helps identify potential risk factors and ensures the surgical plan is tailored to your individual needs.

Pre-Surgical Guidelines

Patients are advised to avoid blood-thinning medications, supplements, and smoking for at least two weeks before surgery. These precautions reduce the risk of complications and support optimal healing. Pre-operative medical testing or imaging may also be performed to further assess nasal anatomy and address any functional concerns.

Step-by-Step Procedure

1. Anaesthesia Administration

Most procedures are performed under IV sedation or general anaesthesia, ensuring patient comfort during the surgery. Minor procedures such as alarplasty, minor revisions, and the insertion of nasal implants can often be done with the patient awake, depending on the complexity.

2. Surgical Process

  • Making Incisions: The procedure begins with either an open rhinoplasty approach involving a small external incision on the columella or a closed rhinoplasty approach, where all incisions are made inside the nostrils. The choice depends on the complexity of the changes required.
  • Reduction Techniques: Cartilage is trimmed and reshaped to achieve the desired proportions, while bone contouring is performed to reduce a dorsal hump or adjust the nasal width. These steps help refine the overall nasal shape for a more balanced appearance.
  • Tip and Nostril Refinement: The nasal tip and nostrils are sculpted to improve their proportions and alignment with the rest of the nose, addressing concerns like bulbosity or wide nostrils.
  • Functional Adjustments: If necessary, structural issues such as a deviated septum or enlarged turbinates are corrected to improve airflow and breathing function alongside the aesthetic changes.

3. Closure and Dressing

Once the reshaping is complete, the incisions are sutured, and a splint is applied to support the nose during the initial healing phase and maintain the new shape.

Balancing Aesthetics and Function in Reduction Rhinoplasty

  • Attention to Functional Aspects

    While aesthetic enhancement is a key focus, the nose’s functional integrity must also be prioritised. Inadequate planning can result in breathing difficulties. Functional concerns, such as nasal congestion, can often be addressed simultaneously during the procedure, ensuring both appearance and functionality are preserved.

  • Facial Analysis and Proportions

    Achieving a balanced outcome requires the nose to align proportionately with the rest of the face in both frontal and side views. Tools such as 3D analysis and computer simulation aid in crafting a nose shape that complements your facial aesthetics.

Post-Surgical Care and Recovery

Immediate Post-Surgery Care

Nasal packing, if used, is removed within 48 hours. Sutures, whether internal or external, are typically taken out after 5–7 days. Splints may be changed on the fifth day and are usually retained for up to 10 days to provide stability.

Swelling Management

Initial swelling begins to subside within 10–14 days, while more noticeable improvements occur within 1–2 months. It may take 6–12 months for the final results to become apparent as residual swelling gradually diminishes.

Recovery Process

Non-strenuous activities, including work, can typically be resumed within 1–2 weeks. Strenuous activities, heavy lifting, or direct pressure on the nose should be avoided until it is considered safe to do so.

Aftercare Recommendations

Keeping the head elevated during sleep and avoiding sun exposure can help minimise swelling and discolouration. Regular monitoring of the healing process is recommended to ensure optimal recovery.

Potential Risks and Complications

As with any surgery, reduction rhinoplasty carries potential risks. Common side effects include swelling, bruising, and temporary numbness, which generally resolve as the healing process progresses. Rare complications may include infection, bleeding, scarring, asymmetry, changes in sensation, or dissatisfaction with the aesthetic outcome. In some cases, revision surgery may be necessary to address concerns or refine the results further. Functional issues, such as persistent congestion, can occur but are typically manageable with appropriate aftercare and follow-up consultations.

Frequently Asked Questions (FAQ)

Can this procedure address previous rhinoplasty issues or asymmetry?

Yes, reduction rhinoplasty can help correct asymmetry and revise irregularities from previous surgeries by reshaping the nasal structure to achieve a more balanced and harmonious appearance.

Am I a suitable candidate for reduction rhinoplasty?

Suitability depends on individual goals, nasal structure, and overall health. A consultation with a qualified surgeon, combined with pre-operative imaging and evaluation, can provide clarity on whether the procedure aligns with your expectations and anatomical requirements.

What happens if I’m dissatisfied with the results?

Revision surgery can be considered if refinements are desired after the healing process is complete. This is typically performed after sufficient time has passed, usually 6–12 months, to allow for proper assessment of the final outcome.

What should I do if I experience prolonged congestion post-surgery?

While mild congestion is common during the healing period, persistent symptoms should be addressed with your surgeon, who may recommend additional evaluation or treatment to resolve the issue effectively.

Can I have reduction rhinoplasty after nasal fillers?

Yes, it is possible to undergo reduction rhinoplasty after having nasal fillers. However, it is generally advised to have the fillers dissolved beforehand to ensure better surgical precision, improved outcomes, and reduced risk of complications.

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Dr Terence Goh

Choosing to combine the intricate skills of microsurgery with aesthetic surgery, Dr Goh specialises in gynaecomastia, surgery of the Asian face, particularly Asian eyelid surgery and rhinoplasty.

Blending the precision of microsurgery with the artistry of aesthetic surgery, Dr Goh has a special interest in gynaecomastia, facial procedures, including ptosis and eyelid surgery, as well as rhinoplasty.

He also offers a full range of body contouring procedures such as mummy makeovers, breast augmentation, liposuction, and body sculpting—designed to help patients feel more confident and comfortable in their own skin.

Beyond aesthetics, Dr Goh remains active in reconstructive microsurgery, with expertise in breast reconstruction, head and neck reconstruction, and lower limb salvage—restoring both form and function where it’s needed most.

  • Bachelor of Medicine, Bachelor of Surgery, National University of Singapore
  • Master of Medicine, National University of Singapore
  • Member of the Royal College of Surgeons
  • Fellow of the Academy of Medicine, Singapore (Plastic Surgery)
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