What can I do to improve my flaring nostrils and upside down arrow look when I smile? Will Alar Base Surgery help? (photo)

The movement that you describe in the tip of your nose is due to the muscles that are at the base of the nose and the lack of support that you have in the nasal tip.  In order to fully correct the problem, I would recommend rhinoplasty to give the tip more support and an alar base reduction as part of the surgery.  A complete examination by your surgeon will determine a more in depth plan for addressing your concerns. 

Alar base reduction will help reduce that dimension of your nose.  You may also want the tip elevated or muscle released to help with the tip depression, but an exam would be more helpful with that.Kenneth Hughes, MDLos Angeles, CA

Hi there,You're quite innocently asking an almost impossible question.The nose, like many other features is dynamic - that is, it changes on expression.  Our nose when our face is in repose is one thing. But its response to expression, such as smiling, is extremely variable. Many peoples nose becomes unappealing to them when they smile - and as they smile in pictures, they see that appearance.To give you a real answer, you will need to post more pictures from front and side views of your nose in repose and smiling, to better demonstrate your concerns.But, in general making your nose prettier when you smile might not be about the nose at all.  It may be about the lip and the face.On the pic you've shown, you look to have a lovely nose in repose. Have you had a previous rhinoplasty? Your nose is not, I think either awful or wide.  Because of mirrors converting you to 2d and you view them from close range, noses often look worse to their owners than to others! A true view of the size is obtained in pictures of you taken from at least 10 feet away, as if taken from closer make the nose look larger.My advice:1. If your nose in general is ok in repose, a non surgical approach almost certainly will help.  A few units of botox in the nasalis muscle (which flares you), and in the base of the columella (which lengthens the nose on smiling), will most likely solve your problems inexpensively.  A total of probably 6 - 8 units twice a year will do it.2. Accept that very few people like their nose appearance when they smile, and mostly nothing really can be dome about it. Don't worry about it - unless the changes you see are quite extreme, and I doubt they will be.  If it looks good in general, it looks good. Surgeons may well overrate their ability to solve an expression problem for you, in truth, and you're probably asking too much of them.3. At the very least, post pictures clearly demonstrating what you see.  If its as you say, it should be obvious in the pictures and we can maybe better advise you.All the very best.