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?

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)

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