Initially, I had only been interested in alarplasty due to the wideness and droopiness of my alae (which is caused by a slightly retracted columella, if you see in my earlier pictures. During the consult with my doctor, he suggested augmenting the tip and lengthening the columella to help with the droopiness and spreading of the alae. Some cartilage would be added to the bridge to give a bit more definition. A slight alar base reduction would also be performed. I stressed that I wanted only slight modifications to my nose, so that it would appear natural.
I had surgery under local anaesthesia... which is common, but definitely uncomfortable; I should have probably opted for general anaesthesia or for some type of sedation and local anaesthesia. The nose is very hard to completely numb, so there were moments where I could feel painful pinching when the anaesthesia wore off. After surgery, my face was definitely swollen, as expected, although the pain was not so bad with the help of painkillers. I did look pretty disfigured though (puffy face, upturned nose) - --- try not to fixate on how you look coming out of the operating room! I know my self-esteem was pretty low the first month after surgery... Patience is definitely needed when trying to evaluate how your surgery went.
My initial thoughts of my nose, within the first two weeks of surgery were that it was too upturned and too augmented. This in effect narrowed my nostrils (augmented tip stretches the nostrils upwards), but also made my nostrils look slightly pinched, due to the existing lack of curvature in my alae. My doctor ultimately decided not remove part of the alar base so that I would not have slit-like nostrils. I realized that swelling causes the nose to be upturned, and it will take awhile to return to "normal", whatever that means. Swelling around the temples and zygoma due to the fat transfer was perhaps the most upsetting for quite awhile because I looked like a muppet.
Fast forward to nearly two months after my surgery, here is what I think:
1) My nose no longer appears to flatten or lose definition when I smile. Having the tip projection helps give me somewhat of an alar crease, which was what I was looking for, so that when I smile, I have a defined nose.
2) My bridge gives definition to the eye and brow area, at least in my opinion
1) My alae seem to droop even more now that my tip is rotated up (I think I had cartilage added to my columella, which fixed my retracted columella, but this did not address the issue of drooping alae sufficiently). This detail was most important to me, as I wanted my alar base to be parallel to/flush with my columella (I was hoping that alar base excisions could also move my alae slightly up, if that makes sense, to make my columella look less retracted).
2) most of the swelling went down, but one side of my nose looks too projected versus the other; it isn't super obvious until you start turning my head to a 3/4 view or profile view. The tip seems slightly crooked due to this asymmetrical swelling - I thought I looked normal at this point, but looking at some recent pictures of me, my nose looks slightly "done". I know that the swelling will take awhile to resolve, but I think any changes to my nose after this point will be pretty subtle; we'll see in a year I guess, and I will update everyone.
3) Long upper lip and drooping of corner of mouth more apparent. This isn't directly caused by the rhinoplasty, as I had both traits before surgery. But with a projected nose/tip, those problems are slightly exacerbated. This is probably the worst side effect I think, because it contributes to an unnatural look. I'm considering depressor anguli oris muscle release or worst case a lip lift to fix this in the future.
Yes, I have a lot of criticisms, but I think most of them are directed towards features that were already a part of my face. The rhinoplasty was effective overall-- I think the doctor applied the necessary and standard techniques involved in asian rhinoplasty, but I do wish I had considered how the rest of my face would look in relationship to my new nose. In general, my nose still seems overprojected (slightly, but surely), and since my mid-face and upper lips are pretty flat, my nose definitely sticks out. Going forward from here, I am considering very small cheek implants to fill out the midface. I will try to give updates every month! :)
Some opinions on Fat transfer: It was a great idea to get some subtle volume, but not the type of structural support I was looking for. Most of the fat in my cheeks disappeared within the first month. At least that gives me the indication that cheek implants may be a better option. Although my doctor also added fat to the temples, forehead, and zygoma to blend the fat transfer results, I think I should have veto'd the addition of fat to my zygoma much harder. It made my face look wider :/ I understand that this technique may appeal to my doctor's sense of aesthetics, but I respectfully disagree with adding any fat to the sides of my zygoma.