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.

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

Answers (10)

Answer: Correcting a pinched tip in revision rhinoplasty

Answer: Correcting a pinched tip in revision rhinoplasty

Answer: Your deep supra-alar creases may be improved by a well-performed Non-Surgical Rhinoplasty.

Answer: Your deep supra-alar creases may be improved by a well-performed Non-Surgical Rhinoplasty.

Recommended reading

Everything you need to know about Revision Rhinoplasty

Our mission is to create a world where every investment in modern beauty is Worth It.

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

Answers (10)

Answer: Correcting a pinched tip in revision rhinoplasty

Answer: Correcting a pinched tip in revision rhinoplasty

Answer: Your deep supra-alar creases may be improved by a well-performed Non-Surgical Rhinoplasty.

Answer: Your deep supra-alar creases may be improved by a well-performed Non-Surgical Rhinoplasty.

Browse related questions

Recommended reading

Everything you need to know about Revision Rhinoplasty

Our mission is to create a world where every investment in modern beauty is Worth It.