How Can I Fix The Loss of Supra-alar Crease After Rhinoplasty on One Side?

In my opinion, this issue is one that does not have a significant negative aesthetic impact on your nose.  Equally important, given your past procedures and the anatomy of this area, it would be difficult and fraught with risk to try to deepen this crease.  For these reasons I would highly recommend you do not pursue treatment for this issue.  In these type of situations, one must shift one's thinking from "how can I make this better" to "how can I accept and be at peace with what I have."  

To create an alar groove cartilage and/or would need to be resected and a bolster dressing used.  This however may create nasal obstruction.  A better option may be to graft the opposite side for better symmetry and function.

Faces are not perfectly symmetrical and neither are noses.  You have already had two revision to try to fix a minor assymmetry that most people will never notice.  It sounds that this seriously bothers you but the risk of having too many surgeries is to cause a worse problem that can lead to an obvious deformity or difficulty breathing.    Please consider the possible risks before flying anywhere on a promise by someone to fix something that is difficult to do and has already failed in the past.

The cartilage graft can cause flattening of supra- alar crease but this is becoming a vicious circle of adding and subtracting grafts and eventually you may end up with frozen nose which is scarred down nose. We all have facial asymmetry and nasal asymmetry. You will not find a perfectly symmetric nose. Your nose look quite nice and I would not recommend further surgery.

The fact that you have had 5 previous surgeries and still have a descent looking nose is a huge success. Trying to get your nose perfect is more likely to have you with an irreversible problem rather than a perfect nose. You will find someone to operate on your nose without much effort - DON'T!  Leave well enough alone and be happy that your nose looks fine as it is.

Best of luck,

Vincent Marin, MD, FACS

San Diego Plastic Surgeon