Are you aware of the risk that the nasal tip can drop by "1.4–2.1 mm" in rhinoplasty?
- The "support structure" that influences satisfaction with rhinoplasty
- The risk of nasal deformity caused by cartilage reduction
- Professional theory to maintain beautiful design
You may worry, "I don't want to have corrections done repeatedly." Based on professional theory, we explain in an easy-to-understand way what truly matters: building the proper foundation of the nose.
Is "simply removing cartilage" dangerous? Why the nasal "support structure" is important
When you want to make your nose appear smaller, you might think simply "we can just remove cartilage." However, carelessly excising cartilage or destroying the structure may increase the risk of nasal deformity in the future.
Inside the nose, there is an important column called the nasal septal cartilage (the cartilage that serves as a wall separating the left and right sides of the nose). To support this column, physicians are designed to always preserve at least 1 cm of an L-strut (the L-shaped cartilage framework that serves as the foundation of the nose).
If appropriatesupport structure (supporting foundation)is not reconstructed before surgery, papers have reported that the height of the nasal tip (projection) can drop by as much as 1.4–2.1 mm.
Rather than simply changing the shape, physicians always prioritize "how to create a strong support structure" to maintain both function (such as breathing) and long-term durability.
"So, how exactly is the design done?" The theory of rhinoplasty that physicians use
In the field of aesthetic medicine, various theories exist for supporting the nasal tip. Among them, what is increasingly emphasized in recent years is the "Quadripod (4-leg) concept," which views the nasal tip as a structure supported by four legs.
Physicians design the nose like a precision building by combining various parts such as the alar cartilage (the cartilage that forms the shape of the nasal tip) and the nasal septum.
Specifically, the columellar strut (the cartilage column that supports the columella) andnasal septal extension(Septal extension: a technique that extends the nasal septum anteroinferiorly) and other techniques are combined to fix the nasal tip at an ideal position.
This makes it possible to precisely control the angle between the nasal columella and nasal tip (Columellar-lobular angle) to the 30–45 degrees considered beautiful for women.
Does the nose become lower one year after surgery? The truth about "tissue absorption" revealed by data
The cartilage absorption rate at 12 months post-surgery is 7.5%–7.8%.
Research using the technique of wrapping finely crushed cartilage in fascia (Diced cartilage wrapped in fascia) suggests that between 12 and 18 months post-surgery, the height of the nasal dorsum (nasal bridge) may decline by approximately 3.2%–7.8%.
Transplanted cartilage gradually becomes incorporated into the body as one's own tissue, during which process its volume may decrease slightly.
For this reason, physicians with specialized knowledge anticipate in advancetissue absorption of approximately 7%–8% (overcorrection), and design the height with meticulous calculation. It is precisely because there is a robust support structure that a beautiful shape is maintained years later.
Is the internet rumor true? Understanding the "optimal cartilage" choice from published research
The internet claims that "〇〇 cartilage is the strongest," but actual research data shows different conclusions.
Cartilage used in nose augmentation primarily includes auricular cartilage (ear cartilage), septal cartilage, and rib cartilage (cartilage from the rib). No single type is inherently superior; it is important to select the optimal one based on the patient's original skeletal structure and skin thickness.
For example, in high-difficulty cases where the nose has become short and contracted (scarred) due to multiple prior surgeries, a technique is used in which strong rib cartilage serves as the support structure, and auricular cartilage is additionally transplanted in combination.
Through this combined approach, the nasal tip height improves significantly by an average of 4.06 ± 1.76 mm, and this improvement remains stable long-term.
Rather than being fixated on a specific material,design based on medical evidence—using the right material in the right place—is the key factor that determines surgical success.
"A high nose" is not what matters most? The secret of the "ligament" that determines satisfaction
However, the story is not so simple.
In creating a beautiful nose, the existence of "ligaments (じんたい)" is just as important as cartilage. The nose contains delicate tissues that connect skin and cartilage, such as Pitanguy's midline ligament and scroll ligaments.
In conventional surgery, these were sometimes excised, but nowadayspreserving ligaments, or carefully repairing themis emphasized.
According to data from published literature, combining reinforcement of the supporting structure through cartilage grafting with ligament repair reduces post-operative dead space and may accelerate swelling resolution.
Furthermore, this combination increases long-term nasal tip stability andreduces the risk of revision surgeryThis demonstrates that beyond millimeter-level height adjustments alone, the "invisible ligament management" inside the nose greatly influences future satisfaction.
If you find yourself wondering, "What about my case?"
Book a free consultation
We do not engage in high-pressure sales. Please feel free to reach out.
Summary of this article
- In rhinoplasty, rather than simply shaving cartilage, creating a robust "supporting structure (foundation)" is the most important factor.
- Precise planning that accounts for cartilage resorption (approximately 7–8%) and anticipates results years ahead is necessary.
- The optimal cartilage material varies depending on each patient's condition, and the key is selecting the right material for the right location.
- By carefully repairing invisible "ligaments," long-term stability and a beautiful outcome can be expected.
If you have concerns about your own nasal structure or which approach might be optimal for you, please feel free to consult with us first. At Zetith Beauty Clinic, we provide consultations based on medical evidence.
References
- Block L, Pfaff M, Harris A, et al. The Crooked Nose: A Practical Guide to Successful Management. Plastic & Reconstructive Surgery. 2022DOI
- Solomon P. et al. Transfixion incision as an initial technique in nasal tip deprojection. Can J Plast Surg. 2008.
- Choi JW. et al. 3D photogrammetric analysis of the nasal tip projection and derotation based on the nasal tip quadripod concept. Aesthetic Plast Surg. 2017.
- Kim YC. Choi JW. Use of Auricular Composite Graft in Rib Cartilage–Based Rhinoplasty for Contracted Nose Correction. Plast Reconstr Surg. 2025.
- Boustany A, Grover R, Alnaeem H, et al. Cosmetic Rhinoplasty. Plastic & Reconstructive Surgery. 2023DOI
- Kim J, Song J, Park S, et al. Tip Extension Suture. Plastic and Reconstructive Surgery. 2014DOI
- Lee S, Sung K, Kim S, et al. Nasolabial Sulcus Rejuvenation: Paranasal Augmentation Using a Folded Dermal Graft. Aesthetic Plastic Surgery. 2022DOI
- Daniel R, Palhazi P, Gerbault O, et al. Rhinoplasty: The Lateral Crura–Alar Ring. Aesthetic Surgery Journal. 2014DOI
- Barone M. et al. Reconstruction of Scroll and Pitanguy's Ligaments in Open Rhinoplasty: A Controlled Randomized Study. Aesth Plast Surg. 2023.
- Çakır B, Genç B, Finocchi V, et al. My Approach to Preservation Rhinoplasty. Facial Plastic Surgery Clinics of North America. 2023DOI
- Daniel R, Kosins A. Current Trends in Preservation Rhinoplasty. Aesthetic Surgery Journal Open Forum. 2020DOI
Author of this article
Hiromitsu NakamuraPhysician
Zetith Beauty Clinic Ginza, Osaka, Fukuoka
He has a track record of presenting research at both domestic and international academic conferences and is involved in technical instruction and education across Zetith Beauty Clinic. He specializes in precision rhinoplasty based on anatomical evidence and pursues natural results tailored to each individual's skeletal structure and tissues.
Author of this article
Hiromitsu NakamuraGinza Clinic Physician
Zetith Beauty Clinic Ginza Clinic, Osaka Shinsaibashi Clinic, Fukuoka Clinic
He has a track record of presenting research at both domestic and international academic conferences and is involved in technical instruction and education across Zetith Beauty Clinic. He specializes in precision aesthetic medicine based on anatomical evidence and pursues natural results tailored to each individual's skeletal structure and tissues.
Summary of this articleIn rhinoplasty, rather than simply shaving cartilage, creating a robust "supporting structure (foundation)" is the most important factor.Precise planning that accounts for cartilage resorption (approximately 7–8%) and anticipates results years ahead is necessary.The optimal cartilage material varies depending on each patient's condition, and the key is selecting the right material for the right location.By carefully repairing invisible "ligaments," long-term stability and a beautiful outcome can be expected.If you have concerns about your own nasal structure or which approach might be optimal for you, please feel free to consult with us first. At Zetith Beauty Clinic, we provide consultations based on medical evidence.ReferencesBlock L, Pfaff M, Harris A, et al. The Crooked Nose: A Practical Guide to Successful Management. Plastic & Reconstructive Surgery. 2022DOISolomon P. et al. Transfixion incision as an initial technique in nasal tip deprojection. Can J Plast Surg. 2008.Choi JW. et al. 3D photogrammetric analysis of the nasal tip projection and derotation based on the nasal tip quadripod concept. Aesthetic Plast Surg. 2017.Kim YC. Choi JW. Use of Auricular Composite Graft in Rib Cartilage–Based Rhinoplasty for Contracted Nose Correction. Plast Reconstr Surg. 2025.Boustany A, Grover R, Alnaeem H, et al. Cosmetic Rhinoplasty. Plastic & Reconstructive Surgery. 2023DOIKim J, Song J, Park S, et al. Tip Extension Suture. Plastic and Reconstructive Surgery. 2014DOILee S, Sung K, Kim S, et al. Nasolabial Sulcus Rejuvenation: Paranasal Augmentation Using a Folded Dermal Graft. Aesthetic Plastic Surgery. 2022DOIDaniel R, Palhazi P, Gerbault O, et al. Rhinoplasty: The Lateral Crura–Alar Ring. Aesthetic Surgery Journal. 2014DOIBarone M. et al. Reconstruction of Scroll and Pitanguy's Ligaments in Open Rhinoplasty: A Controlled Randomized Study. Aesth Plast Surg. 2023.Çakır B, Genç B, Finocchi V, et al. My Approach to Preservation Rhinoplasty. Facial Plastic Surgery Clinics of North America. 2023DOIDaniel R, Kosins A. Current Trends in Preservation Rhinoplasty. Aesthetic Surgery Journal Open Forum. 2020DOIAuthor of this articleHiromitsu NakamuraPhysicianZetith Beauty Clinic Ginza, Osaka, FukuokaHe has a track record of presenting research at both domestic and international academic conferences and is involved in technical instruction and education across Zetith Beauty Clinic. He specializes in precision rhinoplasty based on anatomical evidence and pursues natural results tailored to each individual's skeletal structure and tissues.