Aquiline nose: Shave it down or lower the entire nasal dorsum? Choose based on how much step-off remains

Aquiline nose correction typically combines three operations: shaving down the nasal bridge prominence, cutting the nasal bones (the bone in the upper part of the nose) to adjust width, and refining the nasal tip shape[1]. Recently, a preservation method (a technique that retains as much tissue as possible) that lowers the entire nasal bridge without shaving has become more widespread, and which approach you choose affects whether a step-off is likely to remain afterward[2].

What does the aquiline nose surgery do?

The nasal bridge prominence consists of nasal bone in the upper part and the nasal septum (the wall dividing the left and right nose) and lateral cartilage in the lower part. In aquiline nose correction, this prominence is shaved down, the nasal bones are cut to bring the width closer together, and if needed, the nasal tip shape is also refined—this is the standard approach[1]. If the nasal bridge is curved, combining the shaving operation with left-right nasal bone cutting can address both the curvature and improve the side profile[3].

Why is nasal bone cutting necessary?

When the prominence is shaved, a gap forms between the left and right nasal bones—like removing the peak of a roof. One major purpose of the nasal bone cutting operation is to close this gap[1]. It is also used to narrow wide nasal bones, widen narrow nasal bones, and correct nasal bone bulges, depressions, and curvature[1].

What is the method of lowering without shaving?

Nasal dorsum preservation surgery (surgery that retains the nasal bridge without shaving) is an approach that lowers the nasal bridge by keeping the prominence intact without shaving. How widespread it is and what types of noses it suits are organized in a systematic review that collects many reports[2]. The actual technique varies, with reports combining the lateral band of the nasal septum with internal graft expansion (adding cartilage and other materials)[4]and reports that measure the force pushing back on the nasal bridge and compare different approaches[5]. There is also documentation that when septoplasty is performed together with the preservation method, revision surgery is reduced and satisfaction increases[6].

Where do complications from surgery appear?

Complications from the shaving method include a gap remaining like a roof with the peak removed, saddle nose (a depression in the center of the nasal bridge), and nasal bridge irregularity[1]. When saddle nose and nasal obstruction occur together, cases have been reported where both were corrected simultaneously using costal cartilage (cartilage at the tip of the rib bone)[7]. The more you shave, the less support structure remains for the nose. How much you lower it is decided together with how much support you preserve[1].

Which method is right for me?

For a nose with large prominence and wide nasal bones, the shaving and narrowing method is suitable[1]. For people who want to preserve the original nasal bridge shape or who do not want irregularity in the nasal bridge, the preservation method is an option[2]. However, the preservation method is still in the process of standardization (aligning which steps to follow), and reports vary on which type suits which nose[2].

What to confirm at consultation

During consultation, the doctor will examine where the prominence transitions from bone to cartilage, the nasal bone width, and whether the nasal septum is deviated[1]. If you choose the shaving method, confirm with your doctor whether nasal bone cutting will also be performed; if you choose the preservation method, confirm whether septal surgery will be done simultaneously[6]. It is also helpful to confirm with your doctor how much the nose will be lowered and how much support will remain afterward, as this makes your decision clearer[1].