Help with excessive nostril show - is there a non-surgical option? (Photo)

Question

I’ve never had any cosmetic surgery. My nose is reasonably large but I don’t have an issue with the size, only with the excessive nostril show from the front view of my nose. I was wondering if filler could lower the alar rim/sill? I would prefer a non-surgical option to a full rhinoplasty.

Semih Yildiz, MD, FEBOPRAS · Answer

Filler cannot reliably lower an alar rim or correct true nostril show. In the frontal photo, there appears to be visible nostril show with a possible relationship between the alar rims, columella, and tip position, but one image cannot determine which structure is responsible and an examination may change the recommendation. Injecting filler around the nostril or nasal base may add bulk without moving the rim in a controlled way, and nasal injections carry rare but serious risks including skin loss and vision injury. The treatment depends on the cause. A retracted alar rim may be lowered with a small alar rim graft or composite graft; a hanging columella, short septal support, or over-rotated tip requires a different correction. Some of these can be limited structural procedures rather than a full cosmetic rhinoplasty, but they are still surgery and must preserve the airway. There is no dependable cream, thread, or nonsurgical injection that permanently changes the alar rim position. A rhinoplasty specialist should examine frontal, basal, profile, and smiling views and assess breathing before deciding whether a focused alar procedure is sufficient.

Edward J. Gross, MD · Answer

Based on your question, it sounds like you've already done quite a bit of research. It's understandable that you'd prefer a nonsurgical solution for your concerns, but it appears from your photo that rhinoplasty would yield the best results. You can surgically narrow the nostrils using a technique called Weir incisions. Because rhinoplasty requires extensive knowledge of nasal anatomy, I recommend consulting with a board-certified facial plastic surgeon who is also a certified ENT.

Philip Wasicek, MD · Answer

Hello, 
You could potentially lower the ala/nostrils slightly by use of neurotoxin (such as botox) of the muscles of the lateral nose. This can drop the ala slightly. It is temporary. 
Filler is not an effective option. 
Realistically, the better and more permanent answer is a rhinoplasty. I would recommend being evaluated by a board certified plastic surgeon who specializes in rhinoplasty to understand your goals and best options. 
Hope this helps.

Richard G. Reish, MD, FACS · Answer

Hello and thank you for your question. Based on your photograph, the best way to accomplish decrease nostril exposure is with a well designed surgical rhinoplasty. . Maneuvers for your surgery would include reorientation of the lower lateral cartilage, placement of extended alar contour grafts , among other maneuvers. Make sure you are going to a surgeon with hundreds of long-term before and after pictures on their website with standardized lighting and standardized backgrounds. 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

Best wishes and good luck.

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

Help with excessive nostril show - is there a non-surgical option? (Photo)

Answers (4)

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