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2026.01.23
Be careful with single nasal wing reduction (medial method)｜why it leads to worsening of ACR
As a plastic surgeon certified by the Japanese Society of Plastic and Reconstructive Surgery, I have been involved in many cases of trauma, reconstruction, and congenital diseases, and have cultivated precise techniques and a deep understanding of anatomy. He entered the field of cosmetic surgery out of a desire to bring the power of cosmetics to his patients, as a change in one's appearance can also make one's mind more positive. Her specialties include general treatment of the eye area, injections, and sagging skin. I provide treatments that focus on beauty with the medical stance of "sincerely addressing the ideals of the patient.
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Nasal wing reduction, especially the medial method, is often thought of as "a simple surgery to reduce the spread of the nose.
In practice, however, the wrong choice of technique can lead toACR (Alar-Columellar Relationship: the positional relationship between the nasal wings and the nasal column) worsensThe risk of having an unbalanced noseThere is.
Particular attention should be paid to,Medial method, in which the skin is excised in a crescent shapeis.
Structurally in this way,Change in nasal wing base being retracted downwardwill always occur.
In other words, the nose may be narrower, but the position of the nasal wings and the nasal column is more likely to be compromised.
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Mechanism of ACR collapse
Source: 'Aesthetic Surgery Techniques: Rhinoplasty, 1st Edition' (Kakuseido Publishing Co., Ltd., 2012) p.15 (Figure partially modified for publication)
What is a good ACR?Nasal column base and nasal wing base positioned in a "downward triangle"Arrangement drawing ais.
A natural and beautiful ratio is achieved when the nasal bridge is slightly lower and the nasal wings are slightly higher than the nasal bridge.
However, if only the medial method is used for the type in which the base of the nasal wing is originally lowered,
The nasal wing base moves further downward and the ACR worsens quickly.
As a result, the nasal bridge appears relatively retracted, resulting in a nose that looks uncomfortable when viewed from the front.
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Nose wing reduction is not always the only indication.
In such cases,Nasal Wing Reduction Alone is Dangerousis.
Rather, what should be considered is,
・Nasal septum extension
Cat surgery (rhinoplasty)
Nasal post descent
He said,Surgery to control the lateral side of the nasal columnis.
Nasal septum extension is not done solely for the purpose of "to lower the nasal column," but results inThe nasal tip tends to be elevated from the foundation, resulting in a lowering of the nasal bridge.
In addition, the nasal tip is raised and the nasal wings are naturally elongated,In many cases, the overhang of the nose itself becomes less noticeable.
In other words,By performing nasal septum extension,Surprisingly many cases can be avoided without nasal wing reduction.That's the situation.
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Wrong application of the medial method can be counterproductive.
There are two main causes of the "wide nose."
(1) Wide lateral type of the nasal cavity itself
(2) Strongly curved (rounded) nasal wings
In the case of (1), the medial method is indicated.
However, if the medial method is performed on type (2),
The worst result is that the roundness is further emphasized.will become.
Moreover, this type has originally drooping nasal wings,ACR itself is often already bad.
If the medial method is performed in this condition, the ACR will certainly deteriorate further.
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Cases in which the external method alone is not sufficient
In the case of (2) above,External method is indicatedwill be.
However, there are not many cases where balance is dramatically improved by the lateral method alone.
In reality,
Lateral + Nasal Septum Extension
Medial method + External method
Raising the nostril rim + lateral method
such asComplex surgery is often required.That is the reality.
Even if you only tweak the nose,If the position of the nasal bridge and apex, the foundation of the nose, is out of alignment, the overall impression will not be correct.
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Are we "looking at the trees and not the forest"?
Counseling,I am concerned about the widening of my nose, so I just want a nasal wing reduction."We are very often asked for advice on how to do this.
However, if you choose a surgical technique without regard to the overall balance,The result is an increased risk of an uncomfortable nose.
Exactly,"Look at the tree (the nose) and don't see the forest (the balance of the entire nose)."state of the art.
Of course, the ideal is to "see the forest for the trees," but this is quite difficult to determine accurately unless you are a doctor who does nasal surgery.
Actually, in rhinoplasty,In many cases, it is better to "look at the forest without looking at the trees.is.
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Nose surgery is an orderly process.
Basically, there is an order to nasal surgery.
The first thing to get in order is,Nose tip and nasal bridge (nasal septum extension, rhinoplasty, rhinoplasty, etc.)is.
This is the part that corresponds to the "forest.
Then, if necessary, adjust the "tree" called the noseDo.
This is the basic concept of rhinoplasty.
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■ Summary
Medial nasal wing reduction has the risk of aggravating the ACR and upsetting the overall balance if indicated incorrectly.
If performed without determining whether the cause of the widening of the nose is the "width of the nasal cavity" or the "bulging curve of the nasal wings," it can often have the opposite effect.
It is not only the nose that determines the impression of the nose, but also the three-dimensional structure including the nasal column and apex.
Nasal wing reduction is a surgery that should be chosen based on an understanding of the overall nasal design.
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【Profile】
Masataka Fujihashi, MD, Plastic Surgeon
Leveraging expertise as a board-certified plastic surgeon, I offer comprehensive facial cosmetic procedures including eyelid and nose surgery, facial liposuction, thread lifts, and hyaluronic acid injections. From incisional surgeries and revision procedures requiring delicate design to minimally invasive injections and lifts with minimal downtime, I strive to provide treatments tailored to each patient's ideal outcome.
We are dedicated to achieving natural results and minimizing downtime, pursuing medical care that leaves you feeling confident in your choice through sincere consultations.
Designing natural beauty with trust.
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【Career】
March 2015: Graduated from the School of Medicine, Showa University
April 2015 Showa University Yokohama Northern Hospital Initial Clinical Training
April 2017 Showa University Hospital Department of Plastic Surgery
October 2017 Maebashi Red Cross Hospital Plastic Surgery / Cosmetic Surgery
April 2019 Nishio Municipal Hospital Plastic Surgery Department
April 2020 Showa University Fujigaoka Hospital Plastic Surgery Department
November 2020 Ota Nishinouchi Hospital Plastic Surgery / Cosmetic Surgery
July 2022 Tokyo Rosai Hospital Plastic Surgery / Cosmetic Surgery Department Head
July 2022: R.O.clinic (Part-time), Kusano Taro Clinic (Part-time)
April 2024 Deputy Director, Ginza TA Clinic
November 2025 BIANCA CLINIC
【Professional Affiliations and Qualifications】
Japanese Society of Plastic and Reconstructive Surgery Board-Certified Plastic Surgeon
Member of the Japanese Society of Aesthetic Plastic Surgery (JSAPS)
Member of the Japanese Society of Aesthetic Surgery (JSAS)
