Avoid regret with aquiline nose correction: step-offs and nasal obstruction after reduction

Aquiline nose correction often leads to regret when the hump is shaved down, causing the nasal bridge to become open, sunken, or uneven, or when nasal airflow worsens. It has been noted that hump reduction surgery tends to produce unexpected changes in both appearance and breathing, and revisions are not uncommon.

What can happen after shaving down the hump?

There are three typical outcomes: the nasal bridge remaining open at the top (open roof), saddle nose (a sunken bridge), or an uneven nasal bridge.[1].

When the bone of the hump is shaved, a gap forms along the top of the nasal bridge as if the roof were missing. To close this, osteotomy is usually performed—cutting and bringing the nasal bones together. There are several options for how much to shave and how to close the gap, and each technique has its own characteristics.[1].[2].

Can aquiline nose correction in Asians be done by "shaving alone"?

Shaving alone is often insufficient. Asian humps are relatively small and frequently accompanied by characteristics such as weak support at the nasal tip, and a low nasal root between the eyes[3].

For this reason, an approach that redistributes the height from the nasal root to the nasal tip—not merely removing the hump—is considered necessary[3]Shaving only the hump can paradoxically disrupt the balance of the profile.

Why is support in the central nasal bridge important?

To preserve both appearance and breathing function. Hump-shaving surgery tends to produce unwanted changes in both aesthetics and nasal function, and revision rates are reported to be non-negligible[4]It is established that anticipating changes occurring after surgery during the initial procedure, and carefully reconstructing the central nasal bridge, is important[4].

Causes of nasal obstruction after surgery include excessive narrowing of the nasal bone, collapse of the airway valve, and narrowing due to scar formation[5].

If the hump is lowered without shaving, will it not recur?

Even with the method of lowering the nasal bridge without shaving (dorsal preservation technique), the hump can recur. In a study comparing 231 patients, hump recurrence was seen only in the group using the conventional nasal septal fixation method (72 patients), and complications were more frequent[6].

In the group with improved fixation technique (159 patients), no recurrence was observed, and it was reported that secure fixation of the nasal septum is the key to preventing recurrence[6]This is an example of how the same surgery name can produce different results depending on the specific technique.

What if revision surgery is needed?

In revision surgery, the nasal bridge is often re-supported with cartilage. If too much bone was removed in the previous surgery, a spreader graft—placing cartilage on both sides of the nasal bridge—is used for reinforcement[7].

In a report of 18 patients who underwent revision surgery, when the procedure was performed according to steps matched to nasal bridge stability, the satisfaction score for appearance increased from an average of 12 points to 29 points[8]This is a report from a small number of patients and may not apply to everyone.

Points to confirm at consultation

First, whether the hump will be shaved or lowered without shaving, and what measures address recurrence in each case[6]Second, how the gap after shaving will be closed and how the central nasal bridge will be supported[1][4]Third, whether adjustment of the height of the nasal tip and nasal root is also necessary[3].

The size of your hump and whether the nasal tip has sufficient support cannot be determined without an actual examination. Please confirm these with your doctor, including your breathing condition.