Asian rhinoplasty refers to a specialized subset of rhinoplasty surgery used to reshape the nose to enhance the natural beauty in Asian patients. Experts in this focused surgery will have the ability to not only create projection, augmentation and definition to the nose, but to optimize the overall balance of the nose to complement the entire face.

One area that gets frequently overlooked during Asian nose job surgery remains the ala, alar rims and nostrils. Important considerations to determine the best way to comprehensively address the nostrils and alar include evaluation of the patient-specific anatomy as it relates to facial shape and proportions, but perhaps more importantly the patient-specific aesthetic goals. Every patient wants the nostrils and ala to look natural, and not a single patient wants them to look “pinched”, with Michael Jackson’s nose often pointed to as the kind of result that makes patients afraid of alar base reduction, or even rhinoplasty itself more broadly. A well-designed and executed alarplasty will leave no traces of surgery, while a poorly performed one will make it obvious something was done.

The attachment of the ala to the cheeks is referred to as the alar base, and determines the width of the nostrils. As a general guideline, the distance between the eyes (intercanthal distance) should closely approximate the width of the nostrils, assuming a normal distance between the eyes. When evaluating the cause of the width, attention should be directed at the size of the alar base as well as the width of the nasal sill. The level of flaring of the alar rim and nostril will determine the appropriate design of the alarplasty incision, incorporating the alar base alone (Weir incision), the nasal sill alone, or a combination of both. Some rhinoplasty surgeons mistakenly design the incision above the alar-facial groove instead of within the groove in a misguided attempt to preserve this natural crease, fearing that incisions designed within the crease will blunt it. In fact, with proper closure of the incision the resultant scar will hide within the preserved crease, becoming almost invisible once fully healed. Incisions designed above the alar-facial groove, on the other hand, will leave a scar that will always remain visible.

In addition to the width of the nostrils, the shape and degree of flare of the alar rims determine the overall appearance of the lower third of the nose when viewed from the front. When excess flare is present, the surgeon must carefully assess the contribution of the skin and lower lateral cartilages as well. In patients with thin skin and neutral to concave lower lateral cartilages, alarplasty alone will be extremely effective at reducing the width and flare of the nostrils in a manner that results in a natural and refined appearance. However, in patients with thick skin and convex lower lateral cartilage alarplasty alone without rhinoplasty may result in the tip of the nose and infratip appearing bulbous and even wider than before surgery.

With the recent explosion in popularity of nonsurgical options for reshaping the nose, many patients have questions regarding how does it compare to the more invasive and recovery-intensive surgical nose job. For starters, nonsurgical nose job options remain temporary. While some unscrupulous practitioners, and even some “rhinoplasty surgeons”, will try to inject permanent materials into the nose such as silicone (marketed as Silikon 1000), the fact remains that injecting anything permanent in the nose comes with an unacceptably high risk of complications. The reason is that Silikon 1000 and any other type of silicone is synthetic and not biocompatible, and will actually change in shape over time creating distortion of the surrounding tissue. With microdroplet injections of silicone, these distortions might be small, however the larger issue remains the risk of granuloma and scar tissue formation and fibrosis as a result of the foreign material.

When it comes to safe ways to perform nonsurgical rhinoplasty or liquid nose job, the safest technique currently available utilizes hyaluronic acid fillers. Hyaluronic acid fillers have the benefit of occurring naturally in your body – as it is the component of skin and joints providing elasticity and hydration. In the hands of a rhinoplasty specialist the risk of complications such as vascular compromise and blindness are nearly zero. Nonsurgical rhinoplasty provides great changes to the shape and height of the dorsum, or bridge of the nose, while producing a more minor effect on the shape and projection of the tip of the nose. Another limiting aspect of nonsurgical nose job relates to the nasal bones, nostrils and the shape of the ala, as these are areas that can not be altered during liquid rhinoplasty.

Surgical rhinoplasty creates a permanent change, and the types of aesthetic changes can be more significant and comprehensive. Surgical rhinoplasty addresses the structure and the framework of the nose, and is able to take away excess subcutaneous fat, scar tissue, bone or cartilage while restoring or enhancing the strength and functionality of the naturally present tissues. Functional changes also can only be improved through surgical rhinoplasty, while nonsurgical rhinoplasty will have no effect on nasal function. Alarplasty or alar base modification refers to a specific surgical technique that can be used during rhinoplasty to reduce the width and flare of the nostrils and ala, something that can not be achieved during nonsurgical rhinoplasty.

The minimal downtime and reversibility of nonsurgical nose job is perhaps its greatest selling point versus a surgical rhinoplasty. In the right hands, nonsurgical rhinoplasty will look presentable immediately and you will be able to resume your life right after the treatment. The other great thing is that in the case you don’t like it, or there is a vascular complication, the filler material can be dissolved and the nose returned to its natural state. With surgery, a cast and sutures will remain in place for about a week, and most patients will want 2 weeks to return to work or school, while the majority of swelling will take 3-6 months to resolve.