Dr. Stephen J. Pincus, MD, FACS is a double board-certified facial plastic surgeon with 42 years of experience in Beverly Hills, California. Best known for his specialty in revision rhinoplasty and facial feminization, Dr. Pincus also performs facelifts, rhinoplasty (nose jobs), alarplasty, blepharoplasty (eyelid surgery), neck lifts, otoplasty (ear surgery), and facial implants. The term “alarplasty” means plastic surgery of the ala nasi or nostrils. However, practically speaking, it usually has meant narrowing or bringing in the nostrils or nasal base, if they appear too wide or flared. This may mean excising part of the nostril wall, the nasal floor or both. However, in recent times, because these narrowing procedures have been over-used, inappropriately performed or taken to unnatural extremes, alarplasty has more recently become a plastic surgical procedure to reverse the results of prior narrowing. There are 5 main approaches that I have to accomplish this. The simplest is expanding the nasal base using internal nasal flaps in a V to Y approach. This procedure usually lateralizes each side approximately 2-3mm and the scars are hidden within the nose. If more lateralization (widening) is desired, I use either a composite (skin + cartilage) ear graft to the nasal floor or advancement-rotation flaps from the upper lip. These procedures usually give 3-6mm per side of widening. A graft from each ear is needed per side, since the ideal ear graft cannot be divided in half to accomplish these results for both nostrils. The grafts within the nose produce hardly visible scars and the donor sites in the ear also heal quite well with imperceptible scars. Because there are risks of these grafts not “taking” (esp. if there is a moderate amount of scarring from the prior surgery), I have developed an alternative approach using an advancement-rotation flap from the upper lip. There is essentially no chance of this flap failing, but it may elevate the lateral upper lip slightly. This is usually another positive result in the right patient, but may not be desired in some patients. If elevating the entire upper lip is also desired, a variation of the upper liplift can be performed to also widen the nasal base. This produces 3-6mm of widening per side. There are situations from prior alar/nasal base narrowing where some of the lateral alar wall has been removed. This is especially true when the objective was to significantly reduce flaring. However, this also tends to straighten and lessen the nostril curvature, which may produce an unattractive or unnatural result. In these cases, it may be necessary to take a composite ear graft that is not flat like the one mentioned previously, but three dimensional. It is taken from a part of the ear called the antihelix and has its own risks and complications that can be explained in detail , if a patient is interested in pursuing this. Finally, if a significant amount of widening is desired, a three dimensional Z-plasty can be performed by moving the nostril attachment outward while moving an adjacent flap of cheek skin inward. The procedure is also called a “flip, flop, flap” and can lateralize a nostril 1cm or more.
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Review of Dr. Pincus I cannot recommend Dr. Pincus highly enough! My experience with him has been nothing short of transformative. In 2013, I had my nose and lower eyelids done by him, and I can confidently say that the results were stunning. My nose turned out perfectly natural, complementing my features beautifully. In 2018, I returned for upper eyelid surgery, and the results were equally impressive. Dr. Pincus skillfully removed the excess skin that had been making my eyes appear heavy, giving me a youthful, refreshed look that I absolutely love. Most recently, in December 2024, I underwent a lower facelift along with a corner lip lift, and once again, I am thrilled with the outcome. The results are incredibly natural, and I feel more confident than ever. What sets Dr. Pincus apart is his professionalism and communication. He takes the time to explain every step of the process, ensuring that you feel informed and comfortable before, during, and after each procedure. I appreciate that he never pushes unnecessary treatments; his honesty and integrity are truly commendable. Dr. Pincus is a true genius when it comes to facial aesthetics. I wouldn’t trust anyone else with my face. If you’re considering any cosmetic procedures, I wholeheartedly recommend him. You won’t be disappointed!
I had a few alar base reductions and the last one I did, I only requested the left side as I thought it had hung just a little lower. The doctor did a horrible job and removed a lot of my alar base to the point that my left side looked pinched in. I was severely depressed, thinking that this was something that could not be fixed, and that’s when I found Dr. Pincus. He’s one of the few doctors that actually works on bad alar base reduction and after multiple email/Skype calls, I finally booked my trip to LA. We ended using a composite graft and a v/y on the right side as there was still a base left. Due to the severity of the left side, a composite graft was not enough and a v/y was performed a week later which helped push it out more. Although I was a lot happier with the outcome, I still felt like the left side looked a bit pinched and that’s when we added a cartilage to the left wall which helped push it out. Throughout all of this, Dr. Pincus was very caring and even came to my Airbnb to check on me after the procedure. He’s one of the kindest doctors I have ever met, not many doctors would go out of their way to check on you and even accept multiple Skype calls to make sure you were fully aware of the procedure. I am very happy with how my nose came out, it looks way more symmetrical and natural. Before, my nose looked horribly small and pinched in but now it looks way more natural. If you are someone who had gotten an overly aggressive alar base reduction, just know you do have options, and Dr. Pincus is one of them!!
Dr.Pincus is an exceptional practitioner with a holistic level of knowledge as it pertains to revision. He helped me psychologically recover from a recent procedure that didn't align with what I was expecting. He successfully reversed my overly reduced alar with expertise along with many other corrections. Many doctors told me this couldn't be done, but he delivered with care, transparency, and integrity. I'm finally somewhat getting back to normal with time and patience.
Dr.Pincus is a true artist in his field. I say this with great confidence and satisfaction as I am a prior patient of his since 2002. I had a Septoplasty procedure done by him and it completely boosted my self confidence and made me feel so much better about my appearance. Fast forward 22 years later with now a beautiful daughter, I found myself searching for his artistic services once again for her as she was feeling the same way I did at her age of 17. I wouldn’t trust anyone else to perform a rhinoplasty procedure other than Dr. Pincus himself. Luckily for both of us, he was still practicing his art and not retired as of the time of writing this review. (Hint…hint). As I would have expected, my daughter’s procedure was flawless and better than expected by both of us and my wife. My daughter is ecstatic about her results and it has boosted her confidence level as it did for me 22 years ago. If you’re thinking about having Dr. Pincus perform a specific procedure for you, please don’t hesitate to act as ASAP as his retirement plans may come sooner than you think! Thank you Dr. Pincus for coming through with your experience and expertise after all these years. Wishing you only the best in your future endeavors……
Dr. Pincus is the best. From my initial consulation, to surgery, to post op care and follow up, ever attention to detail was made. He was thoughtful, informative and incredibly experience. So glad I had Dr. Pincus do my nose job. What a great result.
Dr. Pincus was amazing! He came highly recommended by another doctor my family knows, and I couldn’t be happier with how he handled everything. He genuinely cares about his patients and makes it a point to be there for you until you’re completely satisfied. He stayed in constant contact with me throughout the entire process, answering any questions I had and regularly checking in. I had broken my nose pretty badly when I was younger, so fixing it wasn’t easy, but he did an incredible job. I’m forever grateful!
I had an excellent experience with Dr. Pincus. He corrected the uneven tip of my nose( where one side of the nostril had receded upward years after having a rhinoplasty). The asymmetry was apparent. Nine months post op and I'm extryemely happy with the results. Dr. Pincus is very knowledgeable and is a pleasure to work with.
More than 2 years ago I had the worst decision of my life when I paid for an alarplasty with a non-surgeon. It's still hard to remember those days when I couldn't even stare a mirror without triggering suicidal thoughts. To begin with, I never hated my nose shape but I had flared nostrils that was insecure about since my early teens (I guess everyone is insecure about their nose in some aspect). Having a full rhinoplasty wasn't a plan for me since I wanted a subtle change, but I was foolish after all. If we can learn with mistakes, NEVER do something without extensive research. Alarplasty is not simple as we think. Have you notice you can barely find any article talking about "reversing" it? Nostrils are really soft tissue and some mm removed can do a massive difference in your face. When I walked into that "non-surgeon" office I had expectations to boost my self-esteem but I completely ruined it instead. My nostrils were so narrowed that I had to clean it with a cotton swab and the shape was so unnatural and flat that was painful to smile. I was in a such bad state of mind also dealing with COVID pandemic situation going on. My alarbase was so damaged that I thought it was unfixable. That's when I started talking with Dr. Pincus through emails and Skype after discovering Realself. Prior to that, I saw 2 other doctors who didn't hear my wishes, but wanted to give me another nose or "theres nothing you can do about it, just accept" answer. If there's anything I can mention right away is that Dr. Pincus will LISTEN to you. He explained me so many times about the composite ear graft procedure (and I can be a pain in the ass cause I do ask too much). Always so polite and calm. Since I'm not from USA, I waited for 2 years until I was able to travel early this year. In the meantime, I saved money working twice as hard (I'm from Latin America, so my currency is really bad), while I progressively went back to socializing with people after lockdown. I was so ashamed and having panic attacks in the beginning, but for my surprise people don't care about our looks as much as we think. No one was curious if I had something done while I was feeling like a frankenstein monster. My whole family was against another procedure, so I convinced my brother to travel with me. Dr. Pincus saw me in person 2 days before my surgery and I still can remember vividly. It was wild finally seeing him after years exchanging emails, like a dream come true. We agreed about the procedure, he told me about the risks, he showed me some pics from his other patients with successful cases and I felt even more secure. He is undeniably a very skilled surgeon. So the big day arrived and I was still so nervous about having surgery, specially taking anesthesia. But then I woke up, I felt so much happiness while I cried like a little baby when I saw my "old-self" again. This was the feeling I was craving for years. I would do it all over again. The post-OP was a little more tricky than we expected because ear grafts were unpredictable in my case, but Dr. Pincus was always there taking care. I'll never forget that. He's the most human and empathetic doctor I've seen and I'm SO grateful that God gave me the change to meet him. If there's one last thing I can also point out, it's that our minds play tricks and it's our worst enemy. We'll never be 100% satisfied. Most days I like my nose, some days I see flaws (selfies are really self-sabotaging). Going through a revision plastic surgery process is difficult cause you're already hurt, but I can finally say I found some comfort after all this rollercoaster. I feel blessed that I had an improvement and my nose bothers me less. My nose before the revision was horrible and unacceptable to me. If I could travel back in time, I would have had my first rhinoplasty with Dr. Pincus without a doubt. If you're seeking help to solve this nightmare with alarplasty, he's the answer. I shared some pictures from before and after while I'm waiting a full year to see the final result.
Thank God I’ve found Dr.pincus!!! I’ve been wanting to do my revision for about six years. During this whole six years I visited any specialist revision rhinoplasty and plastic surgeons in LA including zoom consultation with the very best names out there in San Francisco and NY. Most of the doctors recommended me to “leave it alone” since what I wanted to fix was “Minor” and they advised that it’s not worth the risk. My nose was un centered and the width of it still bothered me. I do get my fillers at the most popular big surgeon offices here in LA, so I didn’t skip anyone’s opinion:) I was beyond anxious to touch it because I was already happy with the way I looked. sometimes it’s more scary to try to fix something minor so naturally you’ll become more specific and perfectionist. I didn’t feel I found the one this whole time of my searching, till I met Dr.Pincus whom I still can not thank enough! I’ve tested the water before with most/perhaps every surgeon here in LA when it comes to fillers,to try and check if I trust their work and with most of them I felt it would be safe only when it comes to fillers. Some doctors are doing great on Instagram and Reels:) I wanted only a specialist! I was about to schedule my surgery with Dr. Frankel which has a big name here as a great Revision specialist. I saw him 6 years ago +2 more times right before Covid but I didn’t feel he had enough patience or understood what I wanted. Thank god again for finding me Dr.Pincus after 6 years and 2 weeks :) I just knew he is the one right away! The way he cares about your concerns and actually listens it’s very genuine first of all. He’s extremely detailed and patient and above all , of course the best gifted specialist. We discussed about realistic expectation but I had my very high hopes because as mentioned before I was at ease with with how I looked overall. I really can not put in the words how perfect this whole process went with Dr. Pincus!!! He sent me some reference pictures here and there to make sure that I know what I like and that we really have the same idea in mind. that gave me an extra confidence to know that we’re on the same page. I was not even tiny bit nervous at the Day of the surgery. And my nose came out PERFECTLY!!! 100 times better that what I could’ve and want!!! once again I cannot thank and recommend this doctor enough! So if you are very detailed and considering any face MOST NATURAL AMAZING RESULTS he’s my one and only!!!
A truly caring and meticulously gifted doctor! I went in for what was to be a standard basal cell carcinoma removal procedure on my nose but six hours later 80% of my nose had to be removed due to its extremity. This skin doctor could not find a plastic surgeon to even consider figuring out what to do for 24 hours while I was bandaged with a completely carved out exposed nose. Dr. Pincus calmly took the challenge and his assurances and keen follow up during the next 3 month process turned this trauma into an unexpected miracle that is now fully healed and a few years later you can't even tell where the 3"x7" swatch of skin from my forehead was taken to cover the nose which is now only faintly visible and coverable with make-up. I thought I was going to be a monster for the rest of my life and now I love my nose even better than the one I was born with. I am fully grateful for his expertise.
Hello & sorry for your poor post-operative result. Theoretically, anything that can be accomplished via an "open" approach can also be accomplished via a "closed" approach. The only difference is in the degree of accuracy in the diagnosis and the ease in making any corrections. Lifting the skin up and looking down on the bony-cartilaginous nasal structure in place is more accurate than looking through internal nasal incisions &/or delivering the structures out of the nose. Furthermore, making the appropriate corrections with excisions, re-positioning &/or grafting is also much easier and somewhat more certain. Your question should be what is wrong and what is necessary for a correction rather than if any surgery can be done via a "closed" approach. You should seek experts in revision rhinoplasty and see what they think should be done and how they would do it to get the most predictable, successful outcome!
Your nose presents a number of interesting anatomical issues, which gives you the impression of being unaesthetic. Firstly, the tip cartilages are rather wide and seem to make up 75%-80% of the nasal base. Also, it appears the lateral wings (crura) are maldirected upwards instead of more laterally, giving the tip a round or ball-like appearance. Also, the soft tissue beneath the tip, which we call the "soft triangles", are too prominent which is also detracting. An alarplasty is exactly what you do not need, since it would make things worse by exaggerating the central fullness of your tip! You should consider a rhinoplasty by an experienced rhinoplasty surgeon. Having the surgery by someone who does not have an extensive experience with the subtleties I mentioned could lead to the need for revisional surgery afterwards.
It appears that your bump is probably at the lower end of the nasal bones. This could have resulted from inadequate reduction in this area or too much removal of the cartilaginous dorsum below (distal) to it. Without seeing the entire bridge, it is hard to say what should be done. If the bump is further reduced, it may contribute to a greater, unaesthetic depression. My best advice would be to see a nasal specialist to get his in-person opinion.
It's difficult to project what you would consider as a "perfect" endpoint. You do have a tad amount of excess nostril show, but I don't think that narrowing the nostrils via an alarplasty is the answer. I would suggest lowering the nostril rims slightly, and maybe even adding rims grafts Creating a slightly more aesthetic tip with a small graft is also a consideration.
Hello Alexandria. You have flaring of the nostrils which makes your nostrils appear too "open"! My approach would be to reduce the alar walls and not the nasal floors. This would reduce the flaring and decrease the amount of nostril "show" but not decrease the external valves or actual openings, which could cause some degree of nasal obstruction.