Q: I feel my nose is shapeless but want a natural result and not a harsh “pinched” look. Should I have an alar base reduction, or will cartilage trimming be enough? Also, would a lateral cartilage reduction be a good idea?
A: You would achieve a nice result with tip refinement without alar base reduction.
Lateral cartilage reduction will be necessary to refine your tip, but in conjunction with additional support in the form of lateral crural strut grafts. Simply removing excess cartilage in the presence of thick skin will result in loss of structural support and increased and not decreased definition. Removing cartilage without providing additional support is what leads to pinching and collapse over time.
