How soon can I start Accutane (for acne) after an alarplasty?

In the photo the "bumps" or fullness along your alar base incisions appears to be due to tension along the incision line. Depending on how long ago your surgery was, this may relax and improve with further healing. Without a static photo (not smiling) to compare with, it's hard to rule out...

Skin is elastic and stretches. Especially when smiling, the skin along the nose and ala moves. A 2 mm nasal sill incision will create less than 3-4 mm of width reduction.

Intrinsic skin elasticity and the dynamic interactions of the dilator naris with the skin envelope will affect ultimate width reduction after alarplasty more than simply the skin thickness.

The nose pictured is a good candidate for alarplasty with combined nasal sill and Weir incisions. The proportions of the nostril width and tip width is important for the surgeon to consider when designing the incisions.

Based on the proportions of your ala and tip, you're not a great candidate for alarplasty alone. The nostrils would likely lose their natural curvature and would actually result in the tip looking less defined, not more. A minor revision rhinoplasty could enhance the aesthetic of your nasal tip...

The truth is a combination of external and internal incisions will create the most significant narrowing and reduction of flare. Paramount to success is preserving a natural amount of curvature so that the nostrils don't appear "pinched" or "stuck on" while balancing the width of the nasal tip.