Rhinoplasty with nostril tuck - Will this help me achieve my goal of a smaller, narrower nose with nostril symmetry? (photos)

Thank you for your question. You are an excellent candidate for rhinoplasty. 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. 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. Best wishes to you.

Please refer to my previous answer regarding nose narrowing and tip deprojection -- the tip deprojection will improve the nostril appearance as the skin re-drapes around the modified cartilage framework of the tip as it is deprojected. Essentially, the skin envelope contracts around the deprojected tip cartilage, in essence making the nostrils smaller and optimizing symmetry.

For more information on rhinoplasty, please refer to my link below.

Good luck.

Mark K Markarian, MD, MSPH, FACS
Harvard-trained Board Certified Aesthetic Plastic Surgeon

You have very strong tip cartilages. It is those cartilages that make the tip look wide, and make the tip sit low, especially on the 3/4 views, like the second photo you submitted of the 5. Work on those tip cartilages could narrow and elevate the tip. Almost everyone sees *some* sort of asymmetry after surgery, but when that asymmetry appears on a smaller nose, they look smaller, too.
How *much* to elevate the tip, or narrow the tip, or make other changes? We figure that out with morphs, well before surgery. I'd love for you to see some excellent professionally-designed morphs of what could possibly be done with your nose. Morphs could also help you identify better just what's bothering you, and help you set a goal for the rhinoplasty that's accurate for your tastes. Profile and three-quarter views would be particularly important in morphing your nose. (Side note: in my opinion, morphs should really be done by the surgeon, or he should direct an assistant as she makes the morphs. Morphs should be made with a constant eye to what actually *can* be done in surgery, for that particular nose, and the surgeon has that information and judgment best.)
Finally, remember that rhinoplasty is an exquisitely difficult operation to get right, and you should only have surgery if you are able to make yourself very confident in your surgeon's skills. The changes that your nose in particular needs require advanced techniques, and skill that most plastic surgeons don't possess with expertise. For most noses, it's much better to not have surgery than to have inexpertly-performed surgery. Read my essay on how to stay out of trouble while selecting a rhinoplasty surgeon. And it also discusses how to take photos that are best for online evaluations.

Tip-plasty and Alarplasty

You can have the lower half of the nose (tip and nostrils) addressed without breaking the nasal bones. Tip-plasty can address the bulbous tip either through closed or open approach to make it narrow and refined.
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’. However, it is important to note that asymmetry of nostrils is common and cannot be corrected with alarplasty.
Both of these can be done under local anethesia.
Watch the video link below.
Regards
Dr. J

What you call a nostril tuck is known as an alar wedge resection. Sometimes I do this after the rhinoplasty has healed. I do it under local anesthesia so you can participate in the planning and assessment when it’s done. It’s not a bad option in your case because it will allow you some control over how it turns out

Rhinoplasty and nostril symmetry: from your pictures it appears that you have a large nose. More specifically, it appears to be long and over projecting with a tip which is bulbous and plunges somewhat downward with smiling. You do not show a picture from underneath looking up at the nostrils, so it is difficult to see if the nostrils are symmetric, and if they are wide enough to require a nostril tuck. A Rhinoplasty would make a nice difference on your otherwise very pretty face. A minor degree of nostril asymmetry is possible if a nostril tuck is performed along with the rhinoplasty. In most cases a nostril tuck is not needed when performing a rhinoplasty. It is only performed in those cases where the nostrils are excessively wide. In those cases it is always possible that a small asymmetry could result if the nostrils were previously symmetric or persist if they were not. This however is a very minor imperfection compared with the very large potential improvement you could have from a Rhinoplasty .

A closed rhinoplasty approach can accomplish improvement of your nose and an alar-plast can accomplish narrowing wide nostrils. Your nostrils are asymmetrical now, and will still be asymmetrical after the surgery. You also appear to have thick skin in the tip of the nose which is going to prevent refinement in that area. Steroid shot Will Most likely be needed to the first few months after the surgery to reduce the swelling in the tip of your nose when patient have thick skin.