Will Alarplasty Help Fix my High, Flared, Uneven Nostrils? What is Likely Causing This Asymmetry? (photo)

Question

I am interested in getting surgery to fix my nostrils, which are noticeably uneven. The left side is fine, but the right side nostril is bigger and more flared than the other; almost as though it's being pulled upwards. I don't know what is causing this. All I really want to do is make the right side of my nose look like the left side. Will Alarplasty alone help to accomplish this, or is a different/additional procedure likely required?

Paul S. Nassif, MD · Answer

In your case, an alarplasty alone would not help. In general, an alarplasty, or alar base reduction will help reduce the size of the nostrils, making them less wide. Your nostrils do not appear too wide, but appear to be receding upward. Sometimes, when patients have nostrils that flare, it can create the illusion of a hanging columella. The best way to achieve balance in this area is to use cartilage grafts to lower the nostrils. I would recommend a consultation with a board certified surgeon that uses computer imaging software to help get an idea of how your nose may appear following a surgical procedure. Thanks, and I hope this helps answer your questions.

Ali Sajjadian, MD, FACS · Answer

Dear Asymetrique,

	 

	Thank you for sharing you photos.

	 

	I recommend a multifaceted approach when it comes to your case so all your nasal aspects could be addressed proportionally and will better fit your facial features while preserving the natural beauty of your face.

	 

	Without physical examination it is difficult to give you solid planning on how to go about realizing your goal.

	 

	So, it is best if you could seek a consultation with a board certified surgeon of ample experience in the field who will guide you and help you make a well informed decision.

	 

	Best of luck to you.

	Dr. Sajjadian

Michael A. Persky, MD · Answer

Hi Asy,

	 

	A tip-plasty will correct the "offending party", as one of my recent rhinoplasty patients addressed her nasal deformity.  Your question can best be answered after a complete examination of your nose, including inside (your nasal septum may be contributing).  Your best course of action is to consult with a few rhinoplasty experts, and then be sure to choose your rhinoplasty surgeon most carefully.  Alar plasty alone will not correct your assymetry.  Good luck and be well.

	Best,

	Dr. P

William Portuese, MD · Answer

An alarplasty will only reduce the width of the base of the nostrils and does not effect flaring. Flaring of the nostrils can be addressed with a combination of composite grafts or alar rim grafts or baton grafts placed inside the nostril. Patient’s nostrils are never exactly symmetric, so some minor asymmetry is within tolerance either before or after a rhinoplasty surgery.

Peter E. Johnson, MD · Answer

Try not to think of each adjustment in rhinoplasty as a 'procedure', as each step we take to change the nasal form can impact the balance elsewhere. The nasal ala is high and arched and an alarplasty or graft may be the correct step, though it might be necessary to raise the columella to reduce show, and reduce the asymmetric flare with a Weir at the base to fine tune adjustments. Make sure you and your surgeon 'see' and understand your issues and goals the same way.

Mario J. Imola, MD, DDS · Answer

Nostril Asymmetry.  Asymmetry in any part of the nose is essentially due to two basic underlying causes:

	·         Developmental causes in which growth of one side is different from the other side.  In the case of the nostrils this can result in lower lateral cartilage that is more retracted, more arched or attached at a different point to the lip-cheek-nostril complex than on the other side.  Developmental asymmetry is very common not only in the nose but other parts of the face and body.  If you look carefully, some degree of asymmetry is present in the majority of humans involving one body part or another.

	·         Acquired causes which are the result of past trauma or surgery.

	 

	In your case, the front and base views you have provided are good but slightly rotated and therefore it is difficult to make an assessment with 100% accuracy.  Despite this it would appear that the main issue appears that the right nostril margin is retracted upwards more than the left.  In addition the asymmetry may extend somewhat to involve the domes of the nasal tip. Additionally, the columella of your nose demonstrates a mild degree of excess downward extension also known as a hanging columella.  This contributes to excessive nostril show but not to the asymmetry.

	If you desire to address only the alar rim retraction on your right side, a simple alar rim graft done through a closed approach will go a long way to improve asymmetry.  The hanging columella can also be corrected with this simple approach.  Such surgery can be easily accomplished in a 45 minute procedure using oral sedation and local anesthetic. 

	If, on the other hand, you wish to address other issues such as nasal tip width, volume, asymmetry and definition, then I would recommend an open technique to remodel the nasal tip.  Such an approach can improve the balance of the upper half of your nose with the lower half.  I strongly urge you to consult with a surgeon willing to review the possibilities with computer image simulation software.

	 

	Mario J. Imola, MD, DDS, FRCSC.

Barry L. Eppley, MD, DMD · Answer

Your nostril issue will not be corrected by a simple alarplasty or nostril base adjustment. You have an overall larger and asymmetric lower alar cartilage on that side. At the least you will need an alar rim graft to lower the edge of the nostril rim. This may be combined with other tip adjustments if so desired.

Fereydoon S. Mahjouri, MD · Answer

The answer is yes and no. If your only cocern is the asymetrical flaring of the nostril, minimal reduction of the right ala ( alarplasty ) would make your right ala/nostril similar to the left one. However there is room to improve the shape of your nose by performing limited rhinoplasty by correcting the hanging colomella ( nostril show). And if you are interested to have a balanced profile you may consider a chin implant in the same time.

Moneer Jaibaji, MD · Answer

Thank you for your question, your right ala is slightly higher than the left. This may be related right alar retraction related to difference in shape and size of the lateral crura of lower lateral cartilage. Another cause is hanging columella that is more pronounced on the right than on the left side. You need to be seen by a board certified plastic surgeon with special interest in rhinoplasty surgery. Detailed history and exam will lead you to the correct answer to your question.

Mohsen Tavoussi, MD, DO · Answer

The answer to your question is no. Alarplasty will not correct what you perceive as the problem with your nose. Your nose is slightly curved to the right and pulled up on your right side of the face as the result of facial asymmetry which we all have. This subtlle difference pulls the right ala upwards since the right side of your nose is slightly shorter. Treatment is rhinplasty to refine the tip which will bring the lower lateral cartilages down and reduce flaring and columella show. A small chin implant will improve your facial harmony.

Will Alarplasty Help Fix my High, Flared, Uneven Nostrils? What is Likely Causing This Asymmetry? (photo)

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