Would alarplasty and filler make my nose look better? I am not happy with the bridge and flared nostrils (Photo)

Question

Would alarplasty and filler make my nose look better? I am not happy with the bridge and flatted nostril. I do have thick skin. I am also scarred to undergo open rhinoplasty.

Philip Solomon, MD, FRCS · Answer

Augmentation rhinoplasty would be recommended for long term results.  You could undergo closed rhinoplasty with either rib grafting or gortex implantation.   The pros and cons of these procedures should be discussed with your surgeon.   Raising your bridge with temporary filler can give you a sense of results achievable with rhinoplasty.    In my experience filler rhinoplasty is safe when the bridge is raised but nasal tip injection should be avoided.  Alar reduction can be done to modify your nasal base

Kenneth Hughes, MD · Answer

I think that a rhinoplasty can help with nostril and bridge refinement to 
put you closer to your goals.  I would perform this in closed fashion to
 minimize scarring and produce as natural a result as possible.Kenneth Hughes, MDLos Angeles, CA

Oakley Smith, MD, FRCSC · Answer

Some people don't want surgery but still want a better nose. Using a tissue filler is an alternative for some. Making a strong nasal bridge or straightening a crooked nose are the best indications.A thick skinned nose doesn't have as much negative effect with injection rhinoplasty as with conventional nose job surgery. A limiting factor in building up the nasal bridge is the ability of the soft tissue envelope covering the bony cartilaginous framework to accommodate the filler. Once the skin has expanded fully, further filler starts to spread sideways. This of course causes the bridge to widen; not what anyone wants. That said, the scooped out, shallow nasal bridge will improve substantially with a medium cross linked tissue filler. Another advantage is of course surgery can always be undertaken at a later date if a greater degree of improvement is wanted.

William Portuese, MD · Answer

We do not recommend fillers placed in the nose  due to complications that can occur. A closed rhinoplasty procedure can address narrowing the nostrils  and narrowing the bridge line. Thick skin will be an impediment to seeing a very refined result in the tip of the nose.

R. Stephen Mulholland, MD (retired) · Answer

Dear Pinkbug99,

Thank you for your submission and clinical photographs.  It does appear as though you have a somewhat
weak nasal dorsum and bridge.  Surgical
augmentation using rib cartilage or bone, as well as allopathic materials such
as Medpor® or zylastic would be on option to build up the bridge.  You are absolutely right; an injectable soft
tissue filler such as Juvéderm® Voluma&trade; would provide a nice bridge enhancement
for you and this would last upwards of 12 months or more.  I have been performing injection
rhinoplasties, as well as open rhinoplasties, for almost 20 years. I do find that many patients want to explore
the non-surgical options, such as the five-minute nose job, prior to entertaining
surgical procedures and some never perform the surgical procedures and simply
maintain their bridge using injectable techniques.  You do have flared nostrils and alar base
reduction under local anaesthesia would 
be one relatively simple procedure to enhance this area of your nose,
which is quite wide in the soft, lobular bulbous tip region.  Injection rhinoplasty would also soften the
top or open tip plasty could be performed at the time of alar base reduction, which
is a much simpler procedure than a full open external rhinoplasty.

As you can tell from my response, there are many options when
it comes to the nose.  You should seek
the advice of an experienced, certified plastic surgeons and facial plastic
surgeons with extensive rhinoplasty experience. 
I have been performing rhinoplasties for 20 years, having done plastic
surgery and ear/nose/throat, head/neck oncology and find that computer imaging,
using 3D systems, can help guide you in your decision analysis.  For more information, please review the link below as well as the 5 minute nose job page.

I do hope this information has been of some assistance and
best of luck.

Sincerely,

R. Stephen Mulholland, M.D.

Certified Plastic SurgeonYorkville, Toronto

Would alarplasty and filler make my nose look better? I am not happy with the bridge and flared nostrils (Photo)

Answers (5)

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