How to Decrease Indentation and High Nostril Crease After 1st Rhinoplasty

Question

I had rhinoplast one year ago. It looks like I have a pinched tip. The supra alar crease is extremely deep and pronouned, running far up the nose. How can this be fixed? The doctor who did the surgery said that grafts inside the nose will make my nose bigger. I am seeking a permanent result to fix it. What are the options?

Steven J. Pearlman, MD, FACS · Answer

In both primary and revision rhinoplasty, deep nostril, or alar, creases are treated by using grafts of your own cartilage to support the indented tissue. This will make the nose appear a little fuller but it will also look more natural. Deep creases makes the tip of the nose look like it is separate from the nostrils. Deep creases can also mean that the nostril cartilage is collapsed and may block breathing as well. Restoring the contour makes a more natural appearing nose. To mimic changes you can place a q-tip inside your nose and gently push out, just a little, on the dented area to see how this would look.

Sam Naficy, MD, FACS · Answer

this feature can be improved with grafting of the lateral nasal walls - there may be enough cartilage in your septum, if not, a rib graft may be needed

Scott Trimas, MD · Answer

If you are having breathing issues as well as the pinching, it would probably be best to correct those areas with a sturdy cartilage graft to prevent further collapse. Smaller areas can be corrected with fillers or crushed cartilage if support is not needed. You need to see a rhinoplasty expert in your area to better address this problem.

Umang Mehta, MD · Answer

The most common cause of a pinched tip  (what some patients call a "sausage nose") after rhinoplasty is contraction of the skin and soft-tissue envelope of the nose without adequate support of the lower lateral cartilages. In your case, it appears that perhaps the lateral crura of these tip cartilages were too weak or flimsy to support this contraction process. This issue can be corrected in revision rhinoplasty by placing lateral crural strut grafts. These grafts are ideally harvested from your septum (but in some cases from the ear or rib) and sutured underneath the lateral crura to support and strengthen them. When performed by a revision rhinoplasty specialist, this technique should restore a more natural, unoperated appearance to your nose and may improve your ability to breathe. The tip of your nose shouldn't look any bigger or wider and may, in a sense, look less prominent because it blends in better with the rest of your face. Hope this answers your question.

	Regards,

	Umang Mehta, MD

Eric M. Joseph, MD · Answer

I read your concern and reviewed the photo of your nose.

	I have had wonderful success filling deep supra-alar creases with Silikon-1000 as an off-label, permanent injectable filler. In my practice, Silikon-1000 is also used to lower the height of your nostrils with permanent results.

	I attached a photo from my RealSelf gallery demonstrating correction of supra-alar creases after previous rhinoplasty surgery.

	I hope this is helpful for you.

William Portuese, MD · Answer

There are multiple tip techniques to reduce alar crease indentation, which involves on-lay grafts, alar rim grafts, and an alar batten grafts. It really depends on what the issues are and how much cartilage is left inside the nose. A cartilage-depleted nose due to previous surgery will be difficult to repair these types of problems of alar pinching. Asymmetries are best addressed by trimming some of the columellar membranes and caudal septum.

Robert Kotler, MD, FACS · Answer

Hi, Suay.

	Have any local surgeons suggested trying a filling injection? It would be a low-risk solution.

	My colleagues are correct in stating that if you have a breathing problem surgery is needed. However, if the matter is one of appearance, check out the possibility of plumping that somewhat pinched area witha filler.

	-Robert Kotler, MD, FACS

	Beverly Hills, CA

Samir Shureih, MD · Answer

It seems that this type of overresection of the lower lateral cartilage is common in Thailand.

	You had over resection of the lateral portion of the lower lateral cartilage

	The tip is still not refined.

	You need a alar cartilage graft and refinement of the tip. retracted ala is caused by over resection of the lateral part of the lower lateral cartilage.

	Consult a BOARD CERTIFIED PLASTIC SURGEON FOR PROPER DIAGNOSIS AND TREATMENT RECOMMENDATION

Steven Wallach, MD · Answer

If you are complaining about a pinched tip, yes, then cartilage grafts may be the best thing to use to improve that problem.

Oleh Slupchynskyj, MD, FACS (retired) · Answer

Hi,

	The only way to improve the crease would be to use a cartilage graft. The cartilage graft may be very small but could make a big difference.

	Best of  Luck,

	Dr.S.

How to Decrease Indentation and High Nostril Crease After 1st Rhinoplasty

Answers (10)

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