What’s wrong with my alar crease? (Photo)

Question

In 2020 I had rhinoplasty done to remove a dorsal hump. I was very happy with the procedure and the doctor. Now, the front of my nose, when smiling looks terrible. The alar crease is so prominent and now my nose looks like an arrow pointing downwards. It has slowly gotten worse over the years. I have an apt with my surgeon to go over things. Looking for some feedback?

Selcuk Inanli, MD · Answer

Hello! Thank you for your question.
As far as I can see from your photos hhe tip of the nose may become low over the years after the operation, but it should be 1 or 2 millimeters higher during the surgical operation. I recommend a revision operation to get rid of this image.
It would be better face to face consultation.
Best regards!

Eric M. Joseph, MD · Answer

Based on your photos, you appear to have relatively thin nasal skin and an over-projected nasal appearance in the lower 1/3 of your nose, with deep alar creases, and with a drooping tip. If your main concern is the convexity along the lower 1/3 of your nose when you smile, I do not believe that there is a non-surgical approach to address this. If you would be happy simply adding volume to your deep alar creases, depending on your examination, microdroplet Silikon-1000 injections may be considered. Wishing you well moving forward. Sincerely, Dr Joseph

Gianfranco Frojo, MD · Answer

This is a challenging thing to answer over the internet without a physical exam and in person discussion.  It appears that you have a "plunging tip deformity". This can be due to many reasons. I would speak with original surgeon regarding your perception of the nose. If this is not possible, I sometimes recommend finding another American Board of Plastic Surgery Certified Plastic Surgeon. I would recommend finding one with experience in rhinoplasty. Sometimes a second opinion can help the patient understand potential outcomes and why the current nose appears as it is.

Gary M. Horndeski, MD · Answer

Your nose is too long and your nasal columella angle is 90 degrees and needs to be 110 degrees.  You need the nose shortened, the columella and tip rotated upward.

Best Wishes,

Gary Horndeski, M.D.

Sam Naficy, MD, FACS · Answer

Based on your photos you have middle vault collapse and likely also need some additional tip support and support to the nostrils, all of which can be accomplished by revision surgery involving cartilage grafting.

Steven M. Denenberg, MD · Answer

To my eye, the reason your nose looks like an arrow pointing downward is because the nose is long, with the tip sitting in a low position. Almost every nose gets longer with a smile, but after a satisfactory rhinoplasty, where the nose has been shortened enough, even with a smile the nose won't look too long. What I see is that if your tip were elevated, quite a bit actually, in a revision, then the alar crease wouldn't bother you at all.

How *much* to elevate the tip,  or make other changes? We figure that out with morphs, well before surgery. I'd love for you to see some excellent professionally-designed morphs of what could possibly be done with your nose. Morphs could also help you identify better just what's bothering you, and help you set a goal for the rhinoplasty that's accurate for your tastes. Profile and three-quarter views would be particularly important in morphing your nose. (Side note: in my opinion, morphs should really be done by the surgeon, or he should direct an assistant as she makes the morphs. Morphs should be made with a constant eye to what actually *can* be done in surgery, for that particular nose, and the surgeon has that information and judgment best.)

Finally, remember that rhinoplasty is an exquisitely difficult operation to get right, and you should only have surgery if you are able to make yourself very confident in your surgeon's skills. The changes that your nose needs require advanced techniques, and skill that most plastic surgeons don't possess with expertise. It's much better to not have surgery than to have inexpertly-performed surgery. Read my essay on how to stay out of trouble while selecting a rhinoplasty surgeon. And it also discusses how to take photos that are best for online evaluations.

And for those who have had previous surgery, it also discusses how to tell whether your first surgeon should be performing your revision.

Ronald J. Edelson, MD · Answer

Your nose is too long and the nostrils are flaring. It’s actually pretty simple fix. You might want to consider a minor revision

Zoran Potparic, MD · Answer

There is no doubt that this mild deformity can be corrected, possibly with filler? It is best to address this issue with your surgeon. Good luck.

Mats Hagstrom, MD (license on probation) · Answer

To make an accurate assessment regarding the outcome of a plastic surgery procedure we generally need to see a complete set of proper before and after pictures.
If you don’t have before, and after pictures and ask your surgeon to forward, the pictures they took.
We generally do not make Rhinoplasty assessments based on dynamic facial expression.
Contracting muscles of facial expression, can create aesthetic changes in many parts of the face.
We cannot take the impact of muscle tension into consideration when doing rhinoplasty surgery.
For this reason we make assessments for surgery and regarding outcomes without facial expression.
I suggest you follow up with your provider and discuss your concerns with him or her.
 Best,
Mats Hagstrom, MD

What’s wrong with my alar crease? (Photo)

Answers (9)

More Rhinoplasty Questions

In what order should I do rhinoplasty, BBL, hair transplant, buccal fat removal in Turkey?

Am I a good candidate for rhinoplasty, eyelid surgery, lip filler and cheek filler and forehead reduction?

Does this look like it has been broken?

Lowering nostrils (name of procedure and possible doctors who perform such a surgery)

2 years after rhinoplasty - is an improvement possible? (Photo)

Nose tip gets red and cold easily 1.5 years after rhinoplasty (Photo)

WE SEND PRETTY
EMAILS