Request answers from expert doctors:





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

Age: 16 - 29
Plastic Surgery Ear, Nose & Throat
DOCTOR’S ANSWER (3)
Dr Terence Goh
"Plastic Surgeon at AZATACA Plastic Surgery"
(15 Reviews)

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.


Dr Terence Goh
MBBS (Spore), MRCS (Edin), MMed (Surg), FAMS

AZATACA Plastic Surgery

AZATACA Plastic Surgery
38 Irrawaddy Road #06-48
Mount Elizabeth Novena Specialist Centre
Singapore 329563

 

965 views 21 Apr 2019

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.


Dr Tan Kar Su‎
MBBS, MRCS, MMed, FAMS

THE RHINOPLASTY CLINIC ENT FACIAL PLASTICS
38 IRRAWADDY ROAD
Mount Elizabeth Novena Specialist Centre
#04 - 35 Singapore 329563

649 views 25 Jun 2019

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!


Dr Christopher Chui

AZATACA Plastic Surgery
38 IRRAWADDY ROAD
MOUNT ELIZABETH NOVENA SPECIALIST CENTRE
#06 - 48 Singapore 329563

864 views 21 Apr 2019
Not the answer you're looking for? Browse other answers tagged Plastic Surgery Ear, Nose & Throat or ask your own question now FOR FREE.
Consult Doctors. FREE.
Real Doctors, Expert Answers
Connect with Facebook Connect with Google For Doctors
By creating an account, you are indicating that you have read and accepted the DoctorxDentist Terms of Use.
Consult Doctors. FREE.
Real Doctors, Expert Answers
By creating an account, you are indicating that you have read and accepted the DoctorxDentist Terms of Use.
Registration Progress
Step 1: Indicate Topics of Interests
Step 2: Follow Relevant Doctors
Complete!
What are your interests?
Please select at least 3 interests.
NEXT
NEXT
Registration Progress
Step 1: Indicate Topics of doctors
Step 2: Follow Relevant Doctors
Complete!
Follow your favourite doctors
We found some doctors you may like. Click continue to follow them.
CONTINUE
CONTINUE
Consult Doctors. FREE.
Real Doctors, Expert Answers
Continue with Facebook Continue with Google

or

Disclaimer: Any answers provided are for general informational purposes only and is not a substitute for professional medical advice. If you think you may have a medical emergency, call your doctor immediately. Always seek the advice of your doctor before starting or changing treatment.

Continue with Facebook Continue with Google

Disclaimer: Any answers provided are for general informational purposes only and is not a substitute for professional medical advice. If you think you may have a medical emergency, call your doctor immediately. Always seek the advice of your doctor before starting or changing treatment.

YOUR QUESTION HAS BEEN

SUCCESSFULLY SUBMITTED.

YOUR QUESTION

HAS BEEN

SUCCESSFULLY

SUBMITTED.

YOUR ANSWER HAS BEEN

SUCCESSFULLY SUBMITTED.

YOUR ANSWER

HAS BEEN

SUCCESSFULLY

SUBMITTED.

YOUR QUOTE REQUEST HAS BEEN

SUCCESSFULLY SUBMITTED.

OUR DOCTORS WILL GET BACK TO YOU SHORTLY!

YOUR QUOTE REQUEST

HAS BEEN

SUCCESSFULLY

SUBMITTED.

OUR DOCTORS WILL GET

BACK TO YOU SHORTLY!

YOUR THREAD HAS BEEN

SUCCESSFULLY CREATED.

HEAD OVER TO FORUM PAGE NOW

TO JOIN THE DISCUSSION

YOUR THREAD

HAS BEEN

SUCCESSFULLY

CREATED.

HEAD OVER TO THE FORUM PAGE NOW

TO JOIN THE DISCUSSION!

YOUR REVIEW HAS BEEN

SUCCESSFULLY SUBMITTED.

THANK YOU.

YOUR REVIEW

HAS BEEN

SUCCESSFULLY

SUBMITTED.

THANK YOU.

YOUR EMAIL HAS BEEN

SUCCESSFULLY SUBSCRIBED.

THANK YOU.

YOUR EMAIL

HAS BEEN

SUCCESSFULLY

SUBSCRIBED.

THANK YOU.

YOUR CONSULTATION HAS BEEN

SUCCESSFULLY SUBMITTED.

OUR DOCTORS WILL

GET BACK TO YOU SHORTLY.

YOUR CONSULTATION

HAS BEEN

SUCCESSFULLY

SUBMITTED.

OUR DOCTORS

WILL GET

TO YOU

SHORTLY.

MESSAGES TO