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

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.

Doctor Answers 2

Harmony rhinoplasty with Mid-face augmentation

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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.

South Korea Plastic Surgeon
4.8 out of 5 stars 12 reviews

Very difficult asian rhinoplasty

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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 dorsum

Please 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.

Alejandro Nogueira, MD
Spain Plastic Surgeon

These answers are for educational purposes and should not be relied upon as a substitute for medical advice you may receive from your physician. If you have a medical emergency, please call 911. These answers do not constitute or initiate a patient/doctor relationship.