Are my alarplasty goals realistic? (Photo)

The old dictum of having your nostrils edges line up with inner canthus is false IMHO. It was based on caucasian norms and never took into account the ethnic and individual variations.
It is very confusing to measure the alarplasty in mm. Typically it means that if you draw a line from the medial canthus downwards it should touch the sides of the nostrils. However, based on that a 5mm change will be huge. The other way to measure that might be more accurate is to measure the actual width of the wedge removed from the sides at its maximum width.
Another point to remember is that in some patients the width of the nostrils is not as much of an issue as the flare of the nostrils.
The best way IMHO is to think of alarplasty change as small, medium, large and jumbo. Squeeze the upper lip to bring together the nostrils and see how much change do you want.
Regards
Dr. J