Should I Get Alarplasty Along with Rhinoplasty? What Type of Result Should I Expect? (photo)

Question

Hello doctors, I am certain about getting rhinoplasty because I have always had a rather bulbuous tip and wide nose (extended alars). I have a bump and slight largeness to the left side of the nose as well. My main concern is the bulbuousness and the drooping of the tip which ideally, would be the main goal I want out of the rhinoplasty. I would ideally like to have a slimmer nose & more refined/upheld shape to the tip. Can alarplasty achieve that w/o scarring? What should I expect? Thanks!

Toby Mayer, MD · Answer

Rhinoplasty for the ethnic nose can be done to address your concerns of wide tip, filing the bump and reducing the ala. The alar scar should not be noticeable and will give better balance to your nose once the tip is made smaller( so the base doesn't look to wide). Choose an experienced rhinoplasty surgeon who does natural noses.

Eric M. Joseph, MD · Answer

I read your concerns and reviewed your photos:

	I'm glad that the width and droopiness of your tip is more bothersome to you than the width of your nostrils. When I narrow nostrils, I limit the scar to the base of your nose, and this has pros and cons. The benefit is that the scars heal nearly invisibly in everyone, and subtle narrowing may be achieved. The disadvantage is that you will not achieve narrowing of the top of your nostril where it meets the sidewall of your nose. In my view, the lack of visible scarring outweighs the possible benefit of more dramatic narrowing with a visible scar.

	You appear to have thick skin over the tip of your nose, and you may require a tip graft for tip refinement and narrowing. You may also benefit from adding tip support with a columella-strut graft. You could have your bump removed and your bridge narrowed.

	Hope this is helpful for you.

	Dr. Joseph

Ronald Schuster, MD · Answer

It's really hard to tell from your photos. I'm also not sure what you mean by alarplasty. Do you mean alar base resection, when the bottom of the nostrils are made more narrow? Or actual thinning of the nostril thickness itself? The later may cause a little bit of a noticeable scar so be careful. If you're not sure, alar base resection can always be done later as a short little office procedure. Discuss it when you go for your consults.

Ashkan Ghavami, MD · Answer

You are a fantastic candidate for an ethnic rhinoplasty. The nasal bridge should be carefully reduced and incrementally.
	The tip is droopy which requires depressor muscle removal (fairly routine in ethnic noses); tip skin debulking, nostril alar and sill narrowing (conservative and natural); tip raising (without excess nostril show). Please contact us with more questions at ghavamiplasticsurgery.com.

William Portuese, MD · Answer

An alarplasty will simply narrow the width of the nostrils. It will not change any other part of your nose. Removal and sculpting the tip cartilages will feminize and refine the tip, thereby reducing the bulbousness of the tip. If the nasal tip droops upon animation, it can be corrected by releasing the depressor septi ligament. Lower osteotomies and trimming of the scroll area of the nose will also thin and narrow the midthird of the nose.

Darryl J. Blinski, MD · Answer

Alarplasty can achieve the result you want. But scarring very hard to avoid. Best to discuss with your surgeon in detail.

Richard W. Fleming, MD (retired) · Answer

The base of your nose is wide. Alar base narrowing will help to maintain balance when the tip is narrowed. The small scar is rarely visible.

Should I Get Alarplasty Along with Rhinoplasty? What Type of Result Should I Expect? (photo)

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