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.

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

Answers (9)

Answer: Nose shortened and tip rotated upward

Answer: Nose shortened and tip rotated upward

Answer: Features seen when smiling

Answer: Features seen when smiling

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Everything you need to know about Rhinoplasty

Our mission is to create a world where every investment in modern beauty is Worth It.

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

Answers (9)

Answer: Nose shortened and tip rotated upward

Answer: Nose shortened and tip rotated upward

Answer: Features seen when smiling

Answer: Features seen when smiling

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Recommended reading

Everything you need to know about Rhinoplasty

Our mission is to create a world where every investment in modern beauty is Worth It.