Why don't I often see drastic changes like this in Rhinoplasty 'before and after's? (photo)

Hello and thank you for your question. It is possible to decrease the alar base width with this technique.   The most important aspect is to find
a surgeon you are comfortable with. I recommend that you seek consultation with
a qualified board-certified plastic surgeon who can evaluate you in person.
Best wishes and good luck.
Richard G. Reish, M.D.
Harvard-trained plastic surgeon

Large changes to a nose are theoretically possible. The likely hood of the changes looking good and appropriate depend on the patients tissues and the skill of the surgeon. Not all patients can have the changes they want from an anatomy standpoint alone. Not all surgeons produce the same results ie some are better rhinoplasty surgeons than others. See a board certified plastic surgeon who has experience in rhinoplasty. The more complicated the surgery, the more likely a revision is possible. Good luck.

The amount of changes that are performed during the rhinoplasty procedure are measured in millimeters. Usually the most dramatic change after a rhinoplasty  is to shave the dorsal hump down. An alar plasty procedure usually accomplishes removal of a few millimeters of skin at the base of the nostrils to narrow  them. It's also important to have very realistic expectations about what can and cannot be accomplished.