Excess skin at supra alar crease - can this be fixed? (Photo)

Question

My only gripe with my nose is how prominent my alar crease area is and minor width issues. I find that the excess skins creates a lot of 3-dimensionality to a feature I don’t want to stick out, especially from my side profiles, ideally I would want a less obvious smoother crease. I’m not sure what procedures exactly address this nor have I really seen any before and afters that have the same issue.

Gary M. Horndeski, MD · Answer

You have only given a lateral view and no frontal view.  You have what appears to be a dorsal contour deformity of the nose.  It may be possible to perform a rhinoplasty to increase the tip projection and will make the alar look much better.  I would need more photographs to give a more accurate answer.

Best Wishes,

Gary Horndeski, M.D.

Eric M. Joseph, MD · Answer

If the indentations above your nostrils are deep, that tends to be consistent with slight narrowing of the internal nasal valves. If there is no issue with your breathing, these can be softened with permanent non-surgical nose job treatments utilizing microdroplet Silikon-1000. I hope this helps! Sincerely, Dr Joseph

Justin Buro, MD · Answer

Hello! Thank you for your question. What you’re noticing in the supra-alar crease isn’t really “extra skin,” but rather the way the lower lateral cartilages, soft tissue, and skin interact in that area. When the lower lateral cartilages are wider, fuller, or project more, they can create extra roundness at the side of the tip. This makes the crease above the ala appear deeper and more prominent, especially from side angles. It’s a subtle but common feature patients point out when they feel the tip of their nose looks heavy or lacks definition.
Improving this usually involves refining the shape and support of the lower lateral cartilages. Techniques such as a conservative cephalic trim and precise tip suturing can narrow and define these cartilages, while a columellar strut provides stable support to hold the tip in a more refined position. Alar contour grafts can be used to smooth the transition along the crease, softening the shadowing and reducing the three-dimensional fullness that bothers you in profile. In addition, maneuvers such as tip deprojection (slightly setting the tip back) and lateral crural steal (pulling some of that skin and cartilage medially) can further improve the lateral definition and balance of the nose.
Altogether, these adjustments aim to reduce the prominence of the supra-alar crease and create a smoother, more balanced contour that looks natural in both frontal and profile views. The exact plan depends on your anatomy, but your concern is almost certainly one that can be improved with precise rhinoplasty techniques. A consultation with an experienced rhinoplasty surgeon would help confirm which refinements are best suited to your goals.
I hope this answers your question. Best of luck! 
Justin Buro, M.D.

Excess skin at supra alar crease - can this be fixed? (Photo)

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Excess skin at supra alar crease - can this be fixed? (Photo)

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