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

Question

I really don't like my nose. I haven't for many years. I like that it has a straight bridge, but I don't like how my nostrils flare and how my nose kind of looks like an upside down arrow when I smile. I used to cover my nose when I laughed because I was so insecure about it. I don't feel shame now but when I see photos of myself,... I think my nose is awful and wide. (looks bigger in person) Will alar base surgery make my nostrils better? Would it help my tip not look weird when I laugh?

Jennifer Parker Porter, MD, FACS · Answer

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.

Kenneth Hughes, MD · Answer

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

Howard Webster, MBBS (Hons), FRACS · Answer

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.

Barry L. Eppley, MD, DMD · Answer

With mildly flared nostrils and a smiling tip deformity, the combination of nostril narrowing and depressor muscle resection would be beneficial. What additional nasal tip may be needed can not determined from just this one front view of your nose.

Steven Wallach, MD · Answer

If you have flaring nostrils, sometimes an alar base procedure can be performed. You really need to be seen in person to determine what is best.

Robert Mounsey, MD · Answer

Using techniques to narrow the side walls of the nose (or alar base) the appearance of the nose can be enhanced.  In some people the nose droops excessively when smiling and this can also  be improved with surgical techniques of an experienced rhinoplasty surgeon.

Reza Momeni, MD, FACS · Answer

Alar base techniques involve reducing the width of the nose at its base (where the nostrils meet the skin of the upper lip.  It would not change the shape of the tip of the nose or the way that the nose may look while smiling.  Your best bet is to have an in-person consultation with a board-certified plastic surgeon with experience in several rhinoplasty techniques.

Brooke R. Seckel, MD, FACS (retired) · Answer

Thank you for your question.  My concern about alar base resection is that first it could restrict your breathing.   Secondly there will be scars in the alar crease which you must be aware of.  I agree that some tip elevation may help the problem as at least on the frontal few the tip appears to deviate downward.

Richard W. Fleming, MD (retired) · Answer

Your nasal base and flaring of your nostrils rims can be reduced. I need to see more pictures as described on my website to evaluate the rest of your tip.

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

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