Q: I don’t want a pointy tip. I just want my alar base narrowed and some but not a lot of projection. I have thick skin. What I want is only an alarplasty since I can somewhat play with angles and make my nose look like it has a bridge but the wide alar gives it away. Will the surgeon need to shave some bridge for the placement of an implant? That wouldn’t be ok for me if I reject the implant and needs to be removed leaving an even lower bridge.

A: First, I would caution you on the use of synthetic implants in your nose.  While they can provide good results for years – sometimes 20, 30 years – they are never a permanent solution and never become a viable part of your nose.  They also carry a higher risk of infection, migration and extrusion than using grafts made from tissue in your own body (autologous grafts).

There is an important relationship between the proportion of the width of the nostrils relative to the width of the tip, and if the nostril width is reduced without addressing the width of the tip – it will appear even more bulbous in comparison.

Given the thickness of your skin, you will need some degree of tip projection to achieve a refined or “pointy” tip.  Without projection it will be difficult to see the changes made underneath the skin.