How would you go about fixing lack of alar cartilage in nose and droopy tip? (Photos)

These are completely different questions. The first question is you have poor cartilage in your nose (kind of typical for na Asian nose) - how do you fix it? You need more cartilage (such as rib cartilage). The specific techniques re: drooping/etc. are more for the surgeon to decide but ultimately you just need more cartilage. From a quick look at your photos, I'd suggest at least a septal extension graft.

Don't you worry, your case is not atypical at all, asian rhinoplasty cases are well known and mastered by (few) surgeons who devote to complex structure rhinoplasty cases in certain challenging ethnicities.

Essential an asian nose is a nose with underdeveloped skeleton, small bones, cartilages, always a relative or absolut skin deficit, and those skeletal elements the patient was born with are in any case weak and of scarce support, hence your flattened tip, which is not droopy at all but lacking support, maing the tip be shaped like a plateau, lacking projection and upturned or sunken into the nasal pyramid, all these features seen in every and each asian nose.

Your nasal bones are not truly asian, only partially, given they are not as underdeveloped as the tip thus forming a doble angle profile; I believe the osseous bridge is optimal in shape and height, I'd not touch it but use it as reference landmark to set the proper poing of nasal tip reconstruction.

Find help from a good structure rhinoplasty surgeon with at least some experience in asian cases (afroamerican noses are equivalent).

There are many ways to accomplish this, and indeed, cartilage grafts are necessary. When we correct a nasal tip appearance, we treat the nasal tip like a tripod. Since your tip is under projected, we would add projection with a columella strut graft, and likely and extended shield graft. Splitting the lower lateral cartilages at their domes helps to increase projection and rotation, and I do not believe that you would require batten grafts. Those grafts are typically utilized to improve external nasal valve collapse, or the appearance of deep supra-alar creases. Stop! Sincerely, Dr Joseph

Hello and thank you for your question. Based on your photographs, you are a great candidate for rhinoplasty. Maneuvers for your surgery would include dorsal hump reduction, tip refinement, tip elevation, placement of extended alar contour grafts, among other maneuvers. With good surgical technique, you could have an outstanding result. I recommend that you seek consultation with a qualified board-certified rhinoplasty surgeon who can evaluate you in person.

Best wishes and good luck.

Richard G. Reish, M.D.
Harvard-trained plastic surgeon