How can I fix an upturned nose with overly exposed nostrils?

Thank you for your question. At present, there is no standard definition of nostril exposure. However, this is a very common problem that many Asian patients consult for when they see too much of the nostrils from the frontal view and they complain that it gives them a ‘piggy’ appearance. Nostril exposure correction surgery is considered if their subjective nostril show is found to be unacceptable. Whilst subtle, correction of nostril show can profoundly improve the results of your rhinoplasty.

There are two common causes for over-exposed nostrils. As you correctly pointed out, one is an upturned nasal tip and this is commonly due to an exceedingly short nose. The other is less common and due to alar rim retraction which can be something you have from birth or it could be as a result of surgery.

Short nose Alar Retraction

(Left) Short Asian Nose.(Ref: Understanding the Anatomy of the Transverse Nasalis Aponeurotic Fibers and Its Importance in Asian Rhinoplasty Fig. 7)

(Right)Alar rim retraction (Ref: https://emedicine.medscape.com/article/841227-overview)

There are 2 methods to correct overly exposed nostrils:

Non-Surgical Rhinoplasty - A non-surgical rhinoplasty involves using injectable fillers such as hyaluronic acid fillers to change the shape of the nose and lower the nostrils. The advantage of using fillers is that you can lower your nostrils without the expense and downtime of a surgical procedure. However the results only last for the duration of the filler which is usually 6-12 months and this has to be repeated if you want to maintain the new nose shape.

Open Rhinoplasty - An open rhinoplasty (Korean-style) is a technically challenging but rewarding procedure that allows the surgeon to correct the exposed nostrils.

Short nose - In patient with exposed nostrils as a consequence of a short nose leading to an upturned tip, several technical manoeuvres will be required to be performed to achieve a stable result that is permanent

1. Release the nasal envelope (transverse nasalis aponeurotic fascia)

2. Achieve reliable lengthening of the nose with the use of extended spreader grafts or septal extension grafts

3. Extension and derotation of the nasal tip with the use of tip sutures and cartilage graft

4. The use of suture techniques and cartilage graft will help to ensure a stable framework which is crucial to maintain long term results.

Alar retraction - This is a technically challenging deformity which is not easy to correct, especially if it is due to prior surgery. In patients with alar retraction, use of alar grafts or even composite grafts may be required to correct the nostril show.

I hope you find the information provided useful and this can help in your communication when you consult your plastic surgeon. Arrange an in-person consultation with a MOH-accredited plastic surgeon if you are keen to find out more.

Cheers.

Thanks for the question. You are describing what we call a short nose. This is very common in Asian patients. It can also be very common (contracted nose) following infection/ rejection after an implant rhinoplasty.

I won't bore you with the excessive technical details of the different techniques to achieve lengthening, but the simple answer to correct a short nose, is to lengthen it.

Lengthening is most commonly achieved through open rhinoplasty. The material of choice is either the septal, ear or the rib cartilage. What material being better depends on the amount of lengthening required vs the stretchability of the skin.

In infection/ rejection cases, where the skin envelop would have been very scarred, rib is often the best answer. In primary cases (no previous rhinoplasty), the septal/ear cartilage may be sufficient. And this really depends case by case - how much septal/ear cartilage you have vs how thick the skin is vs how much lengthening is required etc.

Hi! What you've described is a common complaint from Asians with short noses.

To address this problem, the nose needs to be lengthened. This is most commonly done with cartilage grafts called septal extension grafts, these can come from your nose, ear or rib.

In addition to lengthening the nose, you will probably need some dorsal augmentation and tip refinement.

In the past it was common for surgeons to use silicone implants that went all the way to the tip of the nose. The problem with this is the high risk of implant extrusion at the tip.

I'd advise you to carefully consider your options and seek an in-person assessment with a qualified plastic surgeon.

Good luck!