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Alarplasty for Bulbous Nasal Tip

There is an integral relationship between the nasal tip and wide nasal alae (nostrils) in Ethnic Rhinoplasty. A bulbous or rounded nasal tip is typically comprised of a flat wide and fatty tip caused by weak tip cartilages, excessive fatty tissue and thick skin in the tip area; these factors not only widen the tip but also lower it, which in turn flares and widens the nostrils.

Alarplasty is a term used for reduction of alar (nostril) width and flaring. This procedure can be performed in several different ways/techniques. Typical ethnic patients are extremely wary of the procedure because results, primarily bad ones, are seen in celebrity Rhinoplasties, specifically in the alar bases of Michael Jackson or Lil Kim's. If not performed correctly, an Alarplasty procedure can result in essentially a flattening or distortion of the nasal facial groove. This type of Alarplasty illustrates the surgeon's attempt to reduce alar flare and hide the incision in the nasal facial groove. Placing an incision in this very location can create flattening or other unnatural curvature of the nasal alae.

Latoya Jackson, Lil' Kim and Michael Jackson

Bulbous Tip Correction

female patient bulbous tip correction

bulbous tip correction NYC

NJ bulbous tip correction

24 year old female who underwent a Primary Rhinoplasty in Beverly Hills. She was disappointed in her bulbous, drooping tip. In addition to having thick skin and fibrofatty tissue in the tip, there was scar tissue under the tip skin. The previous surgeon created the scar tissue by operating in the wrong surgical plane. In addition, the previous surgeon removed too much cartilage in the cephalic portion of the upper lateral cartilages, weakening the tip and causing the bulbous and droopy appearance of the tip.

Dr. Slupchynskyj performed a Revision Rhinoplasty, removing the scar and fibrofatty tissue from the tip. Dr. Slupchynskyj also recreated the tip with septal cartilage strut and shield grafts, reinforcing the tip and diminishing the bulbous and droopy appearance. The patient is 3 months post-op and is delighted with the results.

Nostril Narrowing at the Natural Alar-Facial Groove, leading to
the "Triangle Nostril" Look

The yellow wedge shown in the photo above indicates where the nostril is narrowed at the Natural Alar-Facial Groove. This causes flattening of the nostril and an unnatural "Rhinoplasty look". See celebrities shown above.

One critical requirement for successful correction of an ethnic bulbous tip involves adding cartilage support structures to the nasal tip and also to and within the columella (portion of the nose between the nostrils). Proper placement of strut grafts, shield grafts and other necessary nasal tip cartilage grafts add structure and form to the tip beneath the subcutaneous skin envelope. This also elevates the tip and pulls the flared nostrils and alar base in a "superior" direction, also known as tip projection. It is crucial to gain elevation in the tip area when correcting a bulbous tip as this elevation raises the skin envelope and creates form and definition within the tip structures. This is demonstrated in the before/after photos looking at the sub-nasal vertex view of ethnic bulbous tip rhinoplasties and revisions.

The combination of nasal tip projection and elevation of the tip reduces the bulbous nature of the tip as well as nostril width or alar flare. During this procedure, the last step to be performed is reduction of alar width and flaring since the nasal tip must be set in the proper tip projection.

This is a 25 year old African-American model that was seeking reduction of her bulbous tip and reduction of alar flaring. The approximate location of her flat, thin, lower lateral cartilage is shown in teal. These structures help form the shape of the nasal tip. Dr. Slupchynskyj performed a tip elevation procedure using cartilage strut and shield grafts. The shield graft shape and location is illustrated in orange while the strut graft is shown in blue. The tip was elevated, thus reducing the nasal flaring. In addition, Dr. Slupchynskyj performed an intra-sill horizontal nasal narrowing procedure to reduce the horizontal alar width. The excess fatty fibrous tissue in the nasal tip, shown before in yellow, was removed. This patient also received one dose of subcutaneous Kenalog 40 injection to further reduce scar formation, swelling and bulbously of the tip.

Horizontal Nostril Narrowing with Preservation of the Alar-Facial Groove

Horizontal Nostril Narrowing using Dr. Slupchynskyj's Intrasill Wedge technique, highlighted above in yellow, preserves the Alar-Facial Facial Groove, leading to a leading to a natural-looking and aesthetically pleasing Nostril Narrowing.

 
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  • I’m a good-looking, middle-aged African-American male. I have always had an issue with the thickness of my nose. I've considered surgery for years, but was always overly-concerned with what the reaction would be toward a black man getting Cosmetic Surgery. I finally decided I have always lived my life on my own terms. Why stop now? I ventured out to find the right Dr. I was referred to a well-known Cosmetic Surgeon in Philadelphia. My interaction with him was the most humiliating experience I’ve ever had with a medical professional. The Dr....

  • I am so thankful to have come across Dr. Oleh Slupchynskyj of The Aesthetic Institute of New York and New Jersey. 'Dr. S.' (as I like to call him for obvious reasons, haha) is a Double Board Certified Facial Plastic Surgeon, and it turns out he has an entire website dedicated to his work with African-American patients: www.africanamericanrhinoplasty.com. I was immediately impressed with the wealth of information that he has on his site, including information about his practice, his stellar credentials, his surgical inventions (i.e., the SLUPi...

  • I was terrified of having surgery but after two consultations with Dr. S., my anxiety was alleviated, and this was my biggest hurdle. I was able to see what my results would be after surgery through 'computer imaging'. He spent as much time with me as needed and said I could come back as many times as I wanted before making a decision. That was refreshing. I asked to speak with at least 3 other patients of Dr. S. and did. They shared my initial fear and they helped me by explaining their experiences from a patient's point of view! Dr. S. specia...

  • The doctor is very approachable and personable and I felt that he is really listening to me. He made every effort to be easily accessible via email or phone. He also followed me every step of the process, not only during the surgery but also during the recovery period.

  • Double Board Certified with specialized training and loads of experience in Nose Surgery. I was able to see and discuss my results beforehand thru computer imaging so I felt very comfortable with what my result would be. Having consulted with other Drs. who did not have same training, imaging and were twice the surgical cost, I made my decision.

  • Dr. S. is excellent. From the first visit to the follow-ups I always felt comfortable. Look great and feel great, have recommended him others. Really great bedside manner and I was not the best patient. Thanks Dr. S. I really appreciate your patience!!

  • I had a Rhinoplasty done by Dr. S. and he did exactly what I wanted, which was a custom bridge implant.

  • As a 74 year old African-American woman, I was apprehensive regarding the SLUPlift Surgery. In the past, when I discussed Plastic Surgery with family and friends they spoke negatively about the surgery. Eventually I decided it was something I wanted to do for myself. I found Dr. Slupchynskyj while surfing the Internet and reviewing several of his before and after photos. After meeting the Dr. he assured me that I would be OK — and he was correct. After the surgery, I did not have to take any pain medication and I was out shopping within 4 day...
  • Worth It
    I am a 27 year old, African-American female from the Midwest and I just recently had a Rhinoplasty procedure performed on February 9, 2012. I had known for a long time that I wanted to have the procedure done to correct a bump in the bridge of my nose, reduce the width of my nose, as well as to refine my down-turned nasal tip. This was an operation that I was not going to trust to just anybody, so I spent countless hours researching and looking for a surgeon who had significant experience working with African-American patients. Because I liv...
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