What can I do for my wide nose when I smile? (photo)

Based on your photos, you are a great candidate for rhinoplasty. An alarplasty can be done, but it would be best to make it part of a tip rhinoplasty procedure to refine the tip and support it better. That way it won't droop and widen as much when you smile. Be sure to see a rhinoplasty expert for consulation.

Alarplasty is a very fine and quick procedure that can narrow the nostrils and reduce the flare to soften the appearance. It has other names as well like ‘Weir Excisions’ or ‘Nostril Reduction’. It can be done under local anesthesia. The social down time is about a week. If you want to work from home you can start it the next day. For the procedure you are evaluated to determine how much of a change is needed. In the past surgeons had recommended 2mm to 5mm reduction. This was measured by drawing a vertical line at the lateral sides of the nostrils (alae). However, I prefer to use a mirror and Q-tips to show the patient how much of a change can be accomplished. Pushing with Q-tips from the sides can mimic the change. Patient can also pinch their upper lip near the base of the nose and will show them how much narrowing to expect. I try to quantify the change as small, medium and large. Rarely it can be extra large as well. I always advise the patients to be conservative in the change as it is an irreversible procedure. The procedure historically did not get a lot of attention in plastic surgery. It was always thought of an adjunct procedure done with a rhinoplasty. Historically most ethnic groups did not get rhinoplasties. Hence, the caucasian rhinoplasty was the main procedure that plastic surgeons were trained on. 15 years ago I started making videos on the procedure and putting them on YouTube. In my blogs I started using the term 'Alarplasty' as most doctors and patients were using the term nostril reduction or Weir Excisions. I started noticing that over years the term 'Alarplasty' became popular among patients as well. Today, most patients use the term freely and know a lot about the procedure. I am very excited to see this evolution over the years. My African American patients were especially happy to learn that you can make the nose look small without having to do a full rhinoplasty. Many of them noticed that every plastic surgeon they went to offered a full rhinoplasty.
In summary, Alarplasty is a unique procedure in itself and hopefully more surgeons get trained in it and help more people.
You can visit our alarplasty website to learn all about it.
Click on the video link below to see the details.
Regards
Dr. J


2. Tip-plasty
Tip-plasty is a great procedure to address a bulbous tip only and leave the rest of the nose alone. It can be accomplished through an open or closed approach. The goal is to refine the tip and make it smaller and smoother.
In tips with strong cartilages but thin skin, all that is needed is removing some of the cartilage and softening the rest by gently crushing it (morselizing).
In tips with thick skin and lot of soft tissue or fat, the excess fat and soft tissue is removed along with removing some of the cartilage.
Click on the video link below.
Regards
Dr. J

Alar wedge excision by itself would make a very nice difference. Just beware that not all rhinoplasty surgeons like doing them so you may need to do some shopping around