My nostrils show too much. Do I need a revision rhinoplasty? (Photos)

It appears that you have alar retraction. This is when the alar rim retracts and there is more visibility into the nose. My personal favorite way to fix this is with articulating alar contour grafts. This involves taking cartilage and supporting the lateral rims of soft tissue. The cartilage is also sutured to the midline structure (usually a septal extension graft or columellar strut).

Based on your photos, I agree that you appear to have excessive nostril show, both on front view, and on profile of you. Depending on your examination, microdroplet Silikon-1000 nasal injections may be considered for a lowering your nostril margin several millimeters, and this could improve upon and decrease the amount of nostril show that you can see.

Hello and thank you for your question. Based on your photographs, you may benefit from a revision to help address the alar retraction. Maneuvers for your surgery would include placement of extended alar contour grafts, tensioning the tip, among other maneuvers. With good surgical technique, you could have an outstanding result. I recommend that you seek consultation with a qualified board-certified rhinoplasty surgeon who can evaluate you in person.

Best wishes and good luck.

Richard G. Reish, M.D.
Harvard-trained plastic surgeon

In your case the nostril show from front is side is from wide nostrils. These can be pulled in more to cover the showing of your nostrils. Alarplasty will narrow them a little more and pull them inwards. In some cases we need to pull back the columella (the central pillar) but your columella is the right size.

Alarplasty is a very fine and quick procedure that can narrow the nostrils and reduce the flare to soften the appearance. It has other names as well like ‘Weir Excisions’ or ‘Nostril Reduction’. It can be done under local anesthesia. The social down time is about a week. If you want to work from home you can start it the next day. For the procedure you are evaluated to determine how much of a change is needed. In the past surgeons had recommended 2mm to 5mm reduction. This was measured by drawing a vertical line at the lateral sides of the nostrils (alae). However, I prefer to use a mirror and Q-tips to show the patient how much of a change can be accomplished. Pushing with Q-tips from the sides can mimic the change. Patient can also pinch their upper lip near the base of the nose and will show them how much narrowing to expect. I try to quantify the change as small, medium and large. Rarely it can be extra large as well. I always advise the patients to be conservative in the change as it is an irreversible procedure. The procedure historically did not get a lot of attention in plastic surgery. It was always thought of an adjunct procedure done with a rhinoplasty. Historically most ethnic groups did not get rhinoplasties. Hence, the caucasian rhinoplasty was the main procedure that plastic surgeons were trained on. 15 years ago I started making videos on the procedure and putting them on YouTube. In my blogs I started using the term 'Alarplasty' as most doctors and patients were using the term nostril reduction or Weir Excisions. I started noticing that over years the term 'Alarplasty' became popular among patients as well. Today, most patients use the term freely and know a lot about the procedure. I am very excited to see this evolution over the years. My African American patients were especially happy to learn that you can make the nose look small without having to do a full rhinoplasty. Many of them noticed that every plastic surgeon they went to offered a full rhinoplasty.
In summary, Alarplasty is a unique procedure in itself and hopefully more surgeons get trained in it and help more people.
You can visit our alarplasty website to learn all about it.
Click on the video link below to see the details.
Regards
Dr. J