Is there combination of alar and tip surgery that could make my triangular nose more defined? (photo)

Would it be possible to reshape the nostrils without actually taking in the alar base? It's just that when I smile, the bulb flares out with my nostrils, if that makes sense. I think that taking them in would require taking some of the tip back, which is already droopy. See last two pictures (sorry they are all blurry) for my ideal shape. What would be a good estimate cost-wise? I'm just happy I wouldn't need any bone work. Thank you in advance to all who respond!

Doctor Answers 5

Rhinoplasty for bulbous tip and flared nostrils

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Repairing the bulbous tip involves suture techniques to the lower lateral cartilages.   Thick skin is  a limitation to full refinement. An alar plasty does not necessarily have to be performed, but wide nostrils maybe then out of balance with the remainder of the new tip. Also important to release the depressor septi ligament,( if present) to prevent  the tip from drooping upon smiling.

Seattle Facial Plastic Surgeon
4.8 out of 5 stars 158 reviews

A Fairly Standard Rhinoplasty Would Be The Solution.

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Dear Bulbasour:

If the tip of your nose is a little too bulbous, generally, that can be reduced.It looks like you have thin skin and the cartilage is of average strength. You should respond nicely to sculpture and refinement. You mentioned that when you smiled, the bulb flares out with your nostrils.Unfortunately, that is a tough thing to beat.That is because of somewhat hyperactive facial muscles, but it may also be that one of the muscles that runs between your nose and lip is pulling the tip of your nose down when you smile. That can be corrected because that particular muscle can be detached.The clue to that is when you said "the tip is already droopy." With respect to the imaging that you did, the photo second from the left seems to shows a nose that appears to be a little too narrow on the tip. Now, this is always a matter of taste. As far as not needing any bony work, that is something that should be discussed, because it looks to me like you have a small hump or bump. In any event, you should have consultation.

Before you go for consultation is the time to study up.You should do a lot of homework and learn the anatomy and terminology.You can learn that from visiting websites and reading books.I am proud that my two books (listed below) have always been best-sellers because the readers have found them to be extremely helpful in understanding the mechanics and concepts of cosmetic facial surgery.It is also very helpful to visit websites, spend a lot of time there and see the results in before and after pictures that other patients have received.My, and other, websites generally have descriptions of what was done as well as the before and after photos.

When you go for consultation, I would urge you to have computer imaging so that you can visualize the surgeon's predicted result.The surgeon should show you a result that he feels he is capable of achieving and that you would be happy with.This "meeting of the minds" is extremely important.As I emphasize in my books, consultation without computer imaging has much less value.It is a guessing game otherwise.Descriptions of what can be done are abstract.Cosmetic surgery is a graphic art-form and so you need to see photos and other graphics.

I would urge you to consult with a surgeon who "majors" in cosmetic nasal surgery. Rhinoplasty is a difficult operation, and not all surgeons master it. Some master breast augmentation or tummy tucks or correction of birth defects.Burn work is a separate specialty, as well as pediatric plastic surgery.

There are head and neck/ear, nose and throat surgeons and plastic surgeons who have a lot of experience, after excellent training, who would be appropriate. But look for someone where the rhinoplasty and other nasal surgeries are among the top two or three performed by that practice.That is going to give you a good sense of being in the right spot.

Best wishes,

Robert Kotler, MD, FACS
Over 4,500 nasal procedures performed

Robert Kotler, MD
Beverly Hills Facial Plastic Surgeon
4.8 out of 5 stars 90 reviews

Nasal surgery

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I believe you can have improvement in your tip and alar form with the right surgery.  When you change one aspect of the nose you also alter its relation to the rest of the nose and that area may also need to be addressed.  See a board certified surgeon who does frequent rhinoplasties for an evaluation.  Do not let cost sway your pick of the surgeon.  You get what you pay for.   Donald R. Nunn MD  Atlanta Plastic Surgeon.

Donald Nunn, MD
Atlanta Plastic Surgeon
4.9 out of 5 stars 51 reviews

Is there combination of alar and tip surgery that could make my triangular nose more defined?

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The tip can be refined and elevated without altering the alar base.  This will make the alar base appear wider than it is now.

Find a board certified plastic surgeon who performs hundreds of rhinoplasties and rhinoplasty revisions each year. Then look at the plastic surgeon's website before and after photo galleries to get a sense of who can deliver the results.

Kenneth Hughes, MD

Los Angeles, CA

Broad Bulbous Tip

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If you are in good general health, you appear to be a great candidate for nasal tip surgery. By removing the cephalic portion of lower lateral cartilage, you will have more tip definition and slight elevation of the nasal tip. By narrowing the angle of the lower lateral cartilage, you will have a narrower nasal tip. I believe your expectations can be satisfied with nasal tip surgery. If the septum is too long, it can be shortened one - two mm. 
Consult a Board Certified Plastic Surgeon with Rhinoplasty experience. The cost ranges by location in the country but in my practice the cost for nasal tip surgery including facility, anesthesia, and professional fees is $4100.

Best wishes

George C. Peck, Jr, MD
West Orange Plastic Surgeon
4.8 out of 5 stars 25 reviews

These answers are for educational purposes and should not be relied upon as a substitute for medical advice you may receive from your physician. If you have a medical emergency, please call 911. These answers do not constitute or initiate a patient/doctor relationship.