What's wrong with my nose shape? How can I fix the tip? (photos)

The best surgeon for your nose is one that has experience and expertise in both, since the best set of surgical techniques will depend on your aesthetic goals in combination with your anatomy. Based on your photos, it does appear your tip is slightly wide and ptotic, in the setting of soft tip cartilage and slightly thicker skin. This is a challenging baseline for a traditional rhinoplasty surgeon to successfully navigate, in which case a surgeon with experience adding structure to create definition would be highly beneficial.

For Asian patients a lot of times the tip and the width of the nostrils can make the whole nose look big.
Alarplasty and Tip-plasty is the best option.
Alarplasty:
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’. It can be done under local anesthesia. The social down time is about a week. If you want to work from home you can start it the next day. For the procedure you are evaluated to determine how much of a change is needed. In the past surgeons had recommended 2mm to 5mm reduction. This was measured by drawing a vertical line at the lateral sides of the nostrils (alae). However, I prefer to use a mirror and Q-tips to show the patient how much of a change can be accomplished. Pushing with Q-tips from the sides can mimick the change. Patient can also pinch their upper lip near the base of the nose and will show them how much narrowing to expect. I try to quantify the change as small, medium and large. Rarely it can be extra large as well. I always advise the patients to be conservative in the change as it is an irreversible procedure. The procedure historically did not get a lot of attention in plastic surgery. It was always thought of an adjunct procedure done with a rhinoplasty. Historically most ethnic groups did not get rhinoplasties. Hence, the caucasian rhinoplasty was the main procedure that plastic surgeons were trained on. 15 years ago I started making videos on the procedure and putting them on YouTube. In my blogs I started using the term 'Alarplasty' as most doctors and patients were using the term nostril reduction or Weir Excisions. I started noticing that over years the term 'Alarplasty' became popular among patients as well. Today, most patients use the term freely and know a lot about the procedure. I am very excited to see this evolution over the years. My African American patients were especially happy to learn that you can make the nose look small without having to do a full rhinoplasty. Many of them noticed that every plastic surgeon they went to offered a full rhinoplasty.
In summary, Alarplasty is a unique procedure in itself and hopefully more surgeons get trained in it and help more people.
You can visit our alarplasty website to learn all about it.
Click on the video link below to see the details.
Regards
Dr. J


2. Tip-plasty
Tip-plasty is a great procedure to address a bulbous tip only and leave the rest of the nose alone. It can be accomplished through an open or closed approach. The goal is to refine the tip and make it smaller and smoother.
In tips with strong cartilages but thin skin, all that is needed is removing some of the cartilage and softening the rest by gently crushing it (morselizing).
In tips with thick skin and lot of soft tissue or fat, the excess fat and soft tissue is removed along with removing some of the cartilage.

Regards
Dr. J

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.. 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.
Harvard-trained plastic surgeon