Get the real deal on beauty treatments—real doctors, real reviews, and real photos with real results.Here's how we earn your trust.

see all q&a
Posted underRevision Rhinoplasty q&a

Subcision for alar sill/nasal base tethering, 4 years post op - is this a good option to improve symmetry? (Photos)

Intuitive184500Nov 30, 2025
28 F, 5’2, 105 lbs, combination skin/thin skin. Hello! Really desperate for guidance and advice here. I had my primary rhino at the very end of 2022. Ever since, I’ve had this asymmetry at the alar sill/nostril base (my right side, left side of the picture). I’ve been doing a lot of research on the possible causes and found tethering by scar tissue with possible soft tissue deficit causing the sill/base to be kind of “pulled” lower than the other side of my nose and contribute to the asymmetry at the base as well as the appearance of a wider nostril on the affected side. I don’t feel like I need or want a full on revision, so a non surgical option I came across for this is subcision (to release the tether) +- micro filler to the area. I know this would be a super specialized procedure, ideally done by a provider w extensive knowledge of the nerves/blood supply of the area, so does anyone have any experience with this at all and can comment/suggest/advise? Please, please, PLEASE, and thank you. (PS. Apologies for the pores and the nose hairs). Note: when I push that sunken sill “up” to align with the other side, it basically completely corrects any asymmetry. The skin on the affected sill isn’t as “mobile” as the other side, the appearance of the sill doesn't change with facial movement, and the sulcus on that side (right under the nostril) is much deeper on that side than it is the other, all of which supports the idea of a post-op tether, no? Thank you!

Answers (1)

From board-certified doctors and trusted medical professionals
Richard G. Reish, MD, FACS profile photo
Dr. Richard G. Reish, MD, FACS
Board Certified Plastic Surgeon
4.9 | 1729 Reviews
Answered on Dec 5, 2025
Answer
🔗 Link

More Revision Rhinoplasty Questions

Top Answer
User Avatar
Andrew Miller, MD

Based on your photos, you are a good candidate for revision rhinoplasty. Often times during a closed rhinoplasty, it can be hard to get the tip cartilages exactly symmetical. For a revision, the nose would have to be opened, and possibly some cartilage grafts used to straighten the tip and bring...

+2 answers
Top Answer
User Avatar
Jaime Caloca, Jr., MD

Hello, I have seen septal extension grafts (especially silicone ones) that can literally cause a hole in your nasal skin and expose them. Due to the symptoms that you are experiencing, I do recommend removal. How your nose will look and if you would need a septal graft (from your own septum) or...

+2 answers
Top Answer
User Avatar
Richard G. Reish, MD, FACS

Hello and thank you for your question. Based on your photographs, you may benefit from a tip refining revision rhinoplasty. A surgeon can accomplish this by trimming, suturing, and reshaping the cartilage in your lower nose. Fascial grafts may also be used to help improve tip refinement. Your...

+1 answers
Top Answer
User Avatar
Richard G. Reish, MD, FACS

Hello and thank you for your question. Based on your photographs, there are many ways to add tip projection including soft hybrid cartilage-fascia tip grafts, among other maneuvers. With good surgical technique, you could have an outstanding result. I recommend that you seek consultation with a...

+1 answers
Top Answer
User Avatar
Richard G. Reish, MD, FACS

Hello and thank you for your question. The final results take at least 1.5 years for the swelling to fully resolve. This can require lots of patience and waiting. Steroid injections performed by your surgeon can be extremely helpful. I usually start steroid injections around 1 to 2 months...

+1 answers
Top Answer
User Avatar
Richard G. Reish, MD, FACS

Hello and thank you for your question. Based on your photographs, there are many maneuvers that may help you in a revision, including re-tensioning the tip and placement of extended alar contour grafts . With good surgical technique, you could have an outstanding result. I recommend that you...

+1 answers
See all Revision Rhinoplasty Q&A
See more Revision Rhinoplasty Q&As
See all Q&As
SEE REVISION RHINOPLASTY GUIDE →