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prepping for revision: ideas

http://www.osaps2016.org/abstracts/1.38.7%20B3-7%20%20%20Alar%20Lift%20for%20Rhinoplasty.pdf

Anyone done research on alar lift or lobule reduction ? Found a new article from this year m, first technique of its kind seems like. so far I haven't found any doctors in the US keen enough to pick up on the issue of hanging alae, all seem to default to using weir excisions to fix a broad range of features about the alae

Bulbous nose as of now

bulbous nose due to overly projected and rotated tip. No alarplasty performed but it would have been better to do so.

I think I may know what I need for a revision

Did some more research and going to a consultation in a few weeks. Here's what I'm proposing to address my concerns:
1) alar rim raising/ sail excision technique to address droopy alae (more common in Asian noses, contributes to less alar show and "hanging alae")
2) alar rim graft to address slight alar rim notching that was already present. You can see those notches more prominently when I put very light pressure on either side of my nose ( see pics).

3) trimming tip such that it isn't too upturned and projected.

maybe I'll need all three, perhaps just one but I'm hoping I can get some answers from doctors, for what I'm looking for.

Provider Review

Board Certified Facial Plastic Surgeon
455 O’Connor Dr. , San Jose, California
Overall rating
Doctor's bedside manner
Answered my questions
After care follow-up
Time spent with me
Phone or email responsiveness
Staff professionalism & courtesy
Payment process
Wait times

Dr. Lay is an approachable and attentive person, but I think I would have liked to see a surgeon who did much less to my nose. I understand this is just my personal opinion and for some my result is what they are looking for, but in the end, beauty is in the eye of the beholder/patient. UNfortunately, it was only post op that I discovered two other similar reviews ( one chin implant, other rhinoplasty, mentioned in the comments) describing Dr. Lay similarly: a great person, but not right for the job. I either picked the wrong surgeon for the job or my expectations of a "conservative" result were just lost in translation, and I felt that this surgeon went a little too extreme. It doesn't take too much to make a nose look unnatural on an Asian face. In short, I'm unhappy with the result, I don't think it was botched necessarily, but I would have really liked less projection on the nose and more attention to the relationship between the tip and the alae. Sadly, I am considering spending a bit more to reduce my tip in the future and to forget that I wasn't more careful in choosing my surgical plan. Please be careful when choosing your doctors, whether or not this surgeon is the right fit for you; I don't get the impression that plastic surgeons get a lot of time to personalize your surgery due to their busy schedules, and in this case, a lot of my concerns post op weren't addressed, not that much can be done once the operation is over...Message me if you're considering surgery and would like pics. I took a lot of other pictures down for privacy reasons (coworker finding out etc. )