Would Alarplasty be adequate to reduce wide bulbous Chinese nose and chronic history of acne/seborrheic skin? (Photo)

Question

I am 34 years old Chinese male. A doc recommended I have alarplasty and rhinoplasty, however I do not feel I really need increased projection. I am scarred that a nasal implant will be overly dramatic. I wish just for a subtle change. Would Alarplasty alone be enough to reduce the width? Could I do alarplasty first and if the effect is not adequate then consider an implant? Should external wedge resection rather than internal basal resection be done to achieve the max width reduction?

Donald B. Yoo, MD, FACS · Answer

Alar base modification alone will address the width and flare of your nostrils, but may distort the proportions of your nose by drawing more attention to the bulbosity of the tip of your nose.  A combination of subtle changes to the nostril width in addition to the tip and bridge of your nose can help you to achieve a nice improvement without looking dramatically different.

Charles S. Lee, MD, FACS · Answer

to maintain the correct proportions, I would prefer to do the entire nose, including reshaping the nostrils so that they are less round. Alarplasty alone would not be worthwhile for you.

Toby Mayer, MD · Answer

I would not recommend having wedge resection's since these external scars are usually quite ugly. Narrowing of the nasal base should be done inside your nostrils. I would need to discuss with you your goals to determine what other

Robert Kotler, MD, FACS · Answer

Dear smalldifference;I'm
not sure what kind of “alar plasty” was recommended. Your issues are that the walls of your
nostrils are very thick.These alar are
also very tall, and when you smile, the entire nose is widened. Frankly, I am not sure that any of the
standard procedures can give you exactly what you would like to have, and the
only way to know is to have consultations in which several doctors can render an
opinion.First do some cosmetic surgery homework. The first and most important piece
of homework should be seeking out a qualified, board-certified surgeon (in either
plastic surgery or an otolaryngologist
head & neck surgeon) one who is highly experienced and performs the
procedure you want at least weekly and has done so for a decade. 
You should also be able to see on
the surgeon’s website many hundreds of before and after pictures, showing the
changes in the procedure you want.
You should actually learn more
about what your procedure involves, including: 
How to prepare for surgeryUndergoing the actual surgeryHow long your recovery time should be What to tell othersHow long the surgical rejuvenation should last

Toward that end, many good books about cosmetic surgery
exist. Do a quick computer search of cosmetic plastic surgery books on
Amazon.com or BarnesandNoble.com and you’ll find a wealth of
information and handy coping tips.

Yet another note and reminder about the need for doing
cosmetic surgery research before choosing a surgeon and going ahead with a
procedure: Many, many cosmetic plastic surgery patients who did not investigate
their surgeon – and came away unhappy with the results – will spend months and
years, reading about having the procedure done correctly and finding just the
right surgeon to perform the revision surgery.Focus on finding a nasal super-specialist surgeon. Today’s medicine is an area of
extreme specialization; because medical knowledge doubles every 18 months, even
specialists in a particular field of medicine select and concentrate on just a
handful of procedures, becoming extremely familiar, efficient and adept at
performing or delivering them. For instance, a cardiologist knows all about the
heart, but does not operate on them. A cardiac surgeon handles heart surgeries
but may ask a heart valve specialist to do operations on heart valves. That
heart valve surgeon has gone beyond being a specialist and is now a
super-specialist, which is a medical, (and not advertising) classification.
Likewise, a cosmetic plastic surgeon who specializes in only four to seven
facial procedures has become a super-specialist in say, cosmetic and functional
nose surgery along with a few procedures of the face and neck.The super-specialist is more likely to have
had a fellowship, an arrangement in
which a younger surgeon works at the side of one or more Master Surgeons for a year,
concentrating on and performing only a handful of procedures. Bonus: a super-specialist
works so efficiently, healing is faster because less tissue is disturbed going
in and coming back out. The procedure is also more likely to be done correctly,
the first time. In the case of nose surgery, that’s extremely important in a
field where almost 20 percent of first nose jobs must be redone in a second
revision surgery, owing to the extreme complexity and delicate nature of
rhinoplasty which is widely known as the most difficult cosmetic surgery.
Choosing a super-specialist means having something akin to an insurance policy
in your back pocket.Also ask about Computer Imaging. Here’s how that works: photos are taken
of you as you are and uploaded onto a special computer system
that can
morph your present appearance into an anticipated
after picture (The technology is also known as Computer Morphing.).
Such
imaging is an incomparable learning tool because it provides a forum for doctor-patient
agreement on the after-surgery result
that would satisfy you and is a result the doctor can deliver. After
all, cosmetic surgery is 100% visual. It's about appearance, but without
visuals, everything is left to the imagination.
To anticipate a successful outcome, there must
be a meeting of the minds between surgeon and patient. Why waste your time on a
consultation in which the surgeon can’t demonstrate what he envisions as
the outcome? Would you buy a painting without seeing it? In my opinion, a consultation
without computer imaging is nearly worthless.Best wishes,
Robert
Kotler, MD, FACS

Lily Lee, MD · Answer

I certainly think that you can "stage" this and just do alarplasty for now and see how close the results are to your goal. As for which technique, I would need to see how wide your eyes are from each other as well as a worm's eye view of your nose to differentiate between a truly wide base vs nasal flare. Additionally, a tiny bit of filler (Hyaluronic acid or Radiesse) can be put into the tip of your nose to make the tip just a touch less bulbous without surgery.

Arian Mowlavi, MD, FACS (license on probation) · Answer

Unfortunately, alarplasty alone will not correct the nasal tip so that is proportioned with your dorsum. Although, you may feel that your tip is in the correct position, I do feel that if you improve your tip projection even a 1 to 2 mm you will have improved dorsal and tip proportions. You should consider morphing your preop image to better appreciate this. Also, would recommend you do a complete rhinoplasty rather than in piecemeal fashion.

Frederic H. Corbin, MD (license restricted) · Answer

Thank you for the photos and an alarplasty alone will not give the desired result.  From the photos it looks like you do not need more dorsal height but narrowing of the tip and dors associated with more tip projectionDr Corbin

Richard W. Fleming, MD (retired) · Answer

You can do just an alarplasty initially if you want to minimize the surgery; this will not change your bulbous tip. I would do an internal base resection, not a wedge because there is a significant risk of unfavorable scarring this approach. I would have you see my aestheticians re skin care before surgery to improve post-op healing after the skin excision.  .

Would Alarplasty be adequate to reduce wide bulbous Chinese nose and chronic history of acne/seborrheic skin? (Photo)

Answers (8)

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