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

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?

Doctor Answers 10

Reducing alar crease indentation

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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.  

Seattle Facial Plastic Surgeon
4.8 out of 5 stars 157 reviews

Deep creases in the nose are treated with cartilage grafts

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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.

Steven J. Pearlman, MD
New York Facial Plastic Surgeon
4.9 out of 5 stars 141 reviews

Correction of pinching

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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

Sam Naficy, MD, FACS
Seattle Facial Plastic Surgeon
4.7 out of 5 stars 231 reviews

Consider Filling Injections

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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

Robert Kotler, MD
Beverly Hills Facial Plastic Surgeon
4.8 out of 5 stars 90 reviews

Correcting a pinched tip in revision rhinoplasty

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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.


Umang Mehta, MD

Umang Mehta, MD
Bay Area Facial Plastic Surgeon
4.7 out of 5 stars 52 reviews


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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.


Samir Shureih, MD
Baltimore Plastic Surgeon

Correcting alar depressions

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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.

Scott Trimas, MD
Jacksonville Facial Plastic Surgeon
5.0 out of 5 stars 20 reviews

Decreae Indentation and High Nostril Crease

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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,


Oleh Slupchynskyj, MD, FACS
New York Facial Plastic Surgeon
4.8 out of 5 stars 285 reviews

Pinched tip

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

Steven Wallach, MD
New York Plastic Surgeon
4.2 out of 5 stars 30 reviews

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

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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.

Eric M. Joseph, MD
West Orange Facial Plastic Surgeon
4.9 out of 5 stars 435 reviews

These answers are for educational purposes and should not be relied upon as a substitute for medical advice you may receive from your physician. If you have a medical emergency, please call 911. These answers do not constitute or initiate a patient/doctor relationship.