Southeast Asian Nose - High nostrils, deep alar creases. Can travel to meet w/ Dr. well-experienced in this type of work (Photo)

Question

Lacking a bridge & tip but what bothers me most are the deep c-shape grooves/creases of my alars, giving me a "snarling" look. What can be done to achieve less-pronounced depressions along the nostrils (like that of 6th & 7th photo)? Seems like some form of alarplasty have been the choice among many who wish to decrease alar width/flare & were left with triangular-shaped nostrils, that in my opinion looks quite odd (last 3 photos). Hoping to avoid this should I decide to proceed with any work.

Myung Ju Lee, MD, PhD · Answer

I understand your points as your pictures noticeably
show your concern. The main cause of the deep alar groove is from midface depression
which is one of the facial skeletal characteristics in Asians.

I have seen many similar cases in Souteastern
Asian Nose.  There are particular characteristics,
such as thick skin, short columella, flare alar and midface sunken, and
protruded mouth.

Because of this facial skeleton, midface
area including the nose is depressed contrasting mouth protrusion. In order to
solve this concern by rhinoplasty, it has to start solving the base line of
your nose structure. It is very difficult to achieve a beautiful nose just by
nose surgery because the mid-face will be still sunken and the mouth will be
protruded.

If you want to naturally have slimmer alar
without the notch (pinch) you showed in the pictures, you need to have a strong
material to support your tip projection. You also need to have a higher bridge
and tip projection for reduced alar. The doctor must consider the harmony ratio
of your face and nose and must not simply reduce your alar. I highly recommend
you to undergo rib cartilage rhinoplasty because, 1) You do not have enough
septal cartilage to create a high and strong support of your nose structure. 2)
Rib cartilage can add length to your nose and create a nose shape you desire
(length, height, tip, alar) 3) Septal cartilage OR ear cartilage + silicone implant rhinoplasty has limit to the change in your face/nose.

Therefore, I highly recommend you undergo
mid-face augmentation which elevates your mid-face (basement of the nose near
alar, nostril and philtrum) creating an elegant and harmonized face. The
harmony rhinoplasty that I perform combines the rhinoplasty and mid-face
augmentation for Asian patients. For your case, you should consider undergoing rib cartilage rhinoplasty to the doctor who is expert in Asian rhinoplasty.

Alejandro Nogueira, MD · Answer

Yours is a top difficulty, 10 out of 10, in ethnic rhinoplasties, 5-6 hours of surgical time; reasons as follows:-short nose syndrome, due to massively short septum, short upper lateral cartilages and short lateral cruras; all this needs caudal extension grafts applied on septum and cruras, columella grafting, etc-poorly defined tip, lacking support, this needs columellar strut and tip Sheen's grafting-short columella, eventually some skin flaps to lengthen the columella may be required-low bridge, a cartilage (ear or likely rib) onlay graft is a must in these cases-probably a camouflage dorsal temporalis fascia graft may help to conceal the dorsal graft under your thin skinned dorsumPlease do post or send privately a full set of good quality, well lit and focused standard photos: frontal, both lateral views and both oblique views, also from underneath the nostrils.
Feel free to request any additional information from me.

Southeast Asian Nose - High nostrils, deep alar creases. Can travel to meet w/ Dr. well-experienced in this type of work (Photo)

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Everything you need to know about Asian Rhinoplasty

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Southeast Asian Nose - High nostrils, deep alar creases. Can travel to meet w/ Dr. well-experienced in this type of work (Photo)

Answers (2)

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Everything you need to know about Asian Rhinoplasty

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