Sam Naficy, MD, FACS

The widening of the alae in Asian noses with smiling is due to poor tip support. Doing an isolated alarplasty does not address the poor tip support and can often make it worse, resulting in a wider and droopier tip.

It appears that you need a revision brow lift but with a different technique than was used before. A hairline brow lift will likely be the best fit for you - both in more dramatic results and also in not lengthening your forehead

You don't have a true pollybeak which typically includes poor tip support, supratip fullness, and an over-resected dorsum. You mostly have supratip fullness.

There are 2 issues: excess skin and loss of elasticity, each requiring a different approach Typically the best result is achieved with upper blepharoplasty and CO2 laser resurfacing at the same time

Based on your photos a forehead reduction is the ideal procedure for you. During the procedure the brows can be lifted to the desired level.

The best treatment option for you at this point would be a brow lift and CO2 laser resurfacing done at the same time. It appears that the folds were present before surgery, but obscured by the excess upper eyelid skin.

You are a great candidate for a chin implant combined with a deep neck lift, all done through the same small incision under the chin

Yes, you are likely a good candidate for a chin implant. As you mentioned, fillers do not do a decent job of augmenting weak chins. Fillers are designed for soft tissue augmentation, not for augmenting weak bone structure.

With proper techniques your breathing and appearance can be improved. Best to wait one year before seeking a revision. The revision will more than likely require cartilage grafting to the nose, either from the septum, or from other sites.

Your nose can be successfully improved and you are correct in that only subtle changes are needed. It is likely that the surgeon you spoke with did not have sufficient experience in rhinoplasty.