Can rhinoplasty lessen the alar crease? (Photos)

Question

I have a drooping bulbous nose tip and deep alar creases. Can the deep creases be fixed in a rhinoplasty and/or alarplasty? Or would I be able to get piriform fossa filler either before or after the surgery? Finally, I have a dorsal hump that I don’t mind. Would a surgeon be willing to leave a hump alone and just focus on a tip plasty?

C. Carson Huynh, MD, DMD, FACS · Answer

Hello. Rhinoplasty can lessen deep alar creases when they are related to alar flare, tip support, or the surrounding nasal framework, but the crease may not disappear completely because skin and soft-tissue anatomy also contribute. I would evaluate the tip and alar base together, preserve the nostril rim and airway, and use conservative structural changes rather than simply removing tissue. The goal is a nose that fits the midface and still looks like you.

Semih Yildiz, MD, FEBOPRAS · Answer

In my experience, alar creases and a bulbous or drooping tip can sometimes be addressed during rhinoplasty, but the plan depends on skin, cartilage, alar-base anatomy, and breathing. The two photos show profile views at rest and smiling, but cannot determine whether the crease is primarily soft tissue, cartilage, or shadow. Tip refinement and, when appropriate, conservative alar-base work may improve contour; piriform fossa filler is not a substitute for structural correction and has its own vascular and inflammatory risks. A dorsal hump can sometimes be left alone if it fits the planned tip and profile, but changing one area can alter overall balance. See a rhinoplasty surgeon for examination and discuss function, scars, asymmetry, and realistic limits.

Sinyoung Song, MD · Answer

Hello, this is Dr. Song.Are you referring to the alar crease along the sides of the nostrils, or the nasolabial fold (smile line) next to the nose? Without a frontal photo, it is a bit difficult to give a specific answer.
In general rhinoplasty, it is very common to preserve the dorsal hump and bridge while focusing the surgery on the tip, nasolabial angle, and piriform fossa. Regarding filler for the piriform fossa, we generally do not recommend it&mdash;filler in this area migrates easily and often yields unsatisfactory, short-lived results. For patients with a recessed pyriform aperture or deep bony depression, placing a perinasal (paranasal) implant is a much more structural and effective solution.

Muhammed Fatih Evcimik, MD · Answer

The dorsal hump and drooping of the nasal tip can be corrected with rhinoplasty. However, the alar crease can only be improved minimally because it is a natural structure &mdash; we can only slightly reduce its visibility. We can also correct the downward pulling of the tip when smiling. After surgery, the tip will not drop down when you smile. Also, when viewed from the side, the inside of the nostrils is visible. We need to make this as minimally visible as possible.

Kyle Kimura, MD · Answer

Thank you for your questions and photos. 
In general a rhinoplasty will not affect the alar/cheek groove or crease. This area is best addressed with filler or fat augmentation to blunt the crease. Regarding your next question, a rhinoplasty can absolutely be done without changing the dorsal hump and focusing more on the tip. It is important that you find a rhinoplasty surgeon that understands these goals and goes over all the nuances of rhinoplasty in detail. 
Hope this helps and best of luck,Kyle Kimura, MD

Mert Demirel, MD · Answer

Rhinoplasty can improve a drooping or bulbous tip, but deep alar creases are more difficult to “fix” completely. The alar crease is influenced by skin thickness, facial anatomy, muscle movement when smiling, nostril shape, and the support of the nasal base.
Alarplasty may help if the nostril base is wide or flared, but it does not reliably erase a deep alar crease. In some cases, over-reducing the nostril base can actually make the crease or nostril shape look less natural.
Piriform fossa filler can sometimes soften the shadow beside the nose if the crease is partly due to midface or nasal base hollowing. It is usually better to discuss this with your surgeon before rhinoplasty, because filler can affect surgical assessment. Many surgeons prefer doing surgery first, then considering filler later if a crease remains.
Yes, a surgeon can focus on tip refinement and leave the dorsal hump alone if the hump fits your face and you like it. A tip-plasty can support and rotate a drooping tip, refine bulbosity, and improve the smile-related drop without necessarily changing the bridge.
My advice would be to ask for a conservative rhinoplasty plan focused on the tip and nasal base, not a full “small nose” change. The goal should be better tip support and balance, while accepting that alar creases may improve slightly but may not disappear completely.

Gary M. Horndeski, MD · Answer

A rhinoplasty does not decrease the alar crease. You mention that you have a dorsal hump and a drooping tip. When the drooping tip is rotated to increase projection it may minimize the dorsal hump and you may end up with a super tip deformity. This may need to be filled in to make it look better. Unfortunately, you have not provided a frontal view. You may benefit from an eccentric lip lift, not a bullhorn lip lift. This does 4 things: shortens the distance between your nose and upper lip, increases the mucosa of the upper lip, increases the incisor show and pulls up the corners. This may minimize the crease.

Best Wishes,

Gary Horndeski, M.D.

Best Wishes,

Gary Horndeski, M.D.

Paul E. Chasan, MD, FACS · Answer

Thank you for your question. You are an excellent candidate for rhinoplasty, open or closed based on your surgeon's preferences. I think it is one of the most beautifying surgeries that we do as plastic surgeons. A large portion of my practice is dedicated to rhinoplasty surgery.  Unfortunately, the alar crease is part of your anatomy and is very difficult to change, however we can make the nasolabial fold improved dramatically..  It is important to only see plastic surgeons with extensive experience in rhinoplasty, ie perform at least 6 per month and have performed hundreds of cases. Also, critically evaluate on-line galleries to see if their art form resonates with yours. Rhinoplasty is definitely a grey-haired plastic surgeon's sport. You should be able to have a beautiful result and would enhance your face dramatically. Best wishes to you.

Richard G. Reish, MD, FACS · Answer

Hello and thank you for your question. Based on your photographs, you are a great candidate for rhinoplasty. Maneuvers for your surgery would include dorsal hump reduction, tip refinement, nasal tip deprojection, tip elevation, among other maneuvers. Make sure you are going to a surgeon with hundreds of long-term before and after pictures on their website with standardized lighting and standardized backgrounds. 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. FACS
Harvard-trained board certified plastic surgeon

Best wishes and good luck.

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

Zoran Potparic, MD · Answer

Based on these photos you are good candidate for rhinoplasty. Both areas of your concern are within the scope of corrective rhinoplasty. It would be in your best interest to have in person consultation with a board certified plastic surgeon with expertise in rhinoplasty and discuss these issues in detail. Good luck.

Can rhinoplasty lessen the alar crease? (Photos)

Answers (10)

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