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

How long ago was your surgery? Since you have had so many surgeries it will take longer than normal for that area to contract and asses the real results.

Also, from looking at your pictures it appears that the alar crease on your right side is excessive, and you may have some collapse internally. The actual left side looks more natural. It appears your surgeon did a great job.I have noticed that many patients prefer the narrower alar crease, like in your situation. However; is not anatomically correct due to the pinching and potential nostril obstruction.

I would recommend placing a graft on the left side, although you may not like this, to improve asymmetry  and function.

You may want to keep in mind that the two sides of the nose are never identical, so you may chase this issue without ever getting the result you want, especially with the fact that you have had so many surgeries, which will increase your recovery time, and prolong the final results.

Best of luck,

Michel Siegel MD