Repairing an over-done alarplasty
An alarplasty cuts skin from the nostrils to make them smaller. That skin doesn't grow back. This guide explains, in plain words, the main repair options, what each one can and can't do, and what the research says.
The options at a glance
Four kinds of repair came up again and again. Click a name to jump to it.
| # | Method | What it can do | Scar risk | How proven | Verdict |
|---|---|---|---|---|---|
| 1 | Derotation | Hides uneven nostrils if your tip was turned up. Adds no tissue. | Low | Thin | Helper, not a fix |
| 2 | Composite grafts (ear skin + cartilage) | Two very different ways to place them: | |||
| 2a | Internal | Adds a little size and flare from inside the nostril. | Medium | Good | The middle ground |
| 2b | External | Rebuilds the cut wedge or sill directly. | High | Strong | Works, but shows |
| 3 | Flaps | Skin moved while still attached to its blood supply: | |||
| 3a | Alar lobule flap | Fixes notches and teardrop shapes. Doesn't add size. | Low | One small study | Gentlest option |
| 3b | Lip or cheek island flap | Brings in new living skin, so in theory the most size. | High | Very thin | Promising, unproven |
| 4 | Other options | V-to-Y advancement, fixing weak cartilage, scar release and scar care. | Varies | Varies | Supporting fixes |
"Verdict" is a plain-language summary of the evidence below, not a doctor's rating.
Not sure where to start? Answer three questions Nothing is saved
Before you start
What did the alarplasty take?
The right repair depends on what's missing. Two different cuts cause two different problems.
Sill cut
Skin taken from the floor of each nostril.
Nostrils get smaller. Notches or "teardrop" shapes can form.
Wedge cut
A slice taken from the outside of each wing.
Wings get pulled in. You lose flare.
Both (a "Weir")
Sill and wedge together. A common approach.
Smaller nostrils, notches and lost flare.
Each method below helps with some of these and not others:
- Shape: a round nostril instead of a notch, a teardrop or a flat, pinched wing.
- Size: a bigger opening. This needs new tissue, because the old tissue is gone.
- Flare: wings that curve outward. The wedge cut is what usually takes this.
More on this Notch types, reports, an example
Not every notch is the same notch
- Weak cartilage. The wing caves in because its support was trimmed. Usually fixable with cartilage grafts.
- A rim that's pulled up (retraction). Often fixable with grafts placed inside the nose.
- Skin cut away by alarplasty. The shortage is on the outside, and there's no easy fix. This is the most common case after alarplasty.
Find out what was actually done
Operative reports sometimes leave out or understate the alarplasty. In one case, revision surgeons measured about 5 mm taken from each side, where the original surgeon claimed 2 mm. Get an independent surgeon to examine you and write down the measurements first.
Not every alarplasty is aggressive
Dr. Tolga Bilece, November 2025
A conservative alarplasty: only a thin sliver of outer skin removed, nostril size kept. On the operating table.
Derotation
Tip the point of the nose down a little, so less of the inside of the nostrils shows.
Think of a mug. Tilt it up and you see right inside. Tilt it down and you don't. Derotation tilts the nose down so the uneven nostrils hide.
Nostril show: a lot. This is an over-rotated, "upturned" tip.
The nostril never gets bigger. Derotation changes what people see. It doesn't put skin back.
Can help if
- Your tip got turned up in surgery
- Your alarplasty was mild to moderate
- Your nostrils look better when you push the tip down
Won't help if
- A lot of skin was cut
- Your tip wasn't turned up
- Your wing was stitched too low compared to the columella
Trade-offs
- Usually needs a strong support graft (an SEG, often rib), which can feel stiff
- Overdone, it can look older or droopy
- It's another full nose surgery
Key examples
Dr. Sam Most, June 2023
A long-term revision result. The nostrils look fuller after derotation. This patient never had an alarplasty. Video, so play it on Instagram.
Dr. Ari Hyman, August 2025
Seven months after a revision to bring down an upturned tip.
Bottom line. Only worth it if your tip was turned up. It makes what you have left look its best, often in the same surgery as other repairs. It won't bring back what was cut.
More detail Why it might work, patient experiences, sources
Why it might help
Alarplasty damage is easiest to see when a lot of the nostril shows. Many patients also have their tips turned up in the same surgery, which puts the notches and uneven sides on display. Surgeons do treat nostril show as a real, fixable problem and even classify how the rims sit (Rohrich and Afrooz, 2019). But nobody has published derotation as an alarplasty repair. The idea comes from patients comparing hundreds of before and after photos.
The mirror test
In a mirror, gently push your nose tip down using your upper lip and cheek muscles. If the wings flare out more, rotation is probably part of your problem. If nothing changes, you're most likely missing skin. It's a rough clue, not a diagnosis.
What patients report
If there is more rotation, there is more nostril show. So you see the alarplasty deformity more easily.
A patient who researched derotationNostril flare can be currently improved with downrotation. Flaps and skin grafts do not help for flare.
A patient with eight surgeries, who was against derotation at firstWith severe alar issues, simple derotation will not fix the issue.
The same patient, months earlier, about her own case. Derotation pulled her nostrils further up, not out.
One patient's nostrils looked wider after his revision even though their size didn't change: his surgeon made the tip stick out less and propped up the collapsed wings. Later, a surgeon told the same patient his real issue was how the rim had been stitched, not rotation, and a US surgeon turned him down, saying his skin might not allow the derotation he wanted. Get examined before betting on this.
US surgeons named most often for strong derotation: Dr. Sam Most and Dr. Ari Hyman. Dr. Scott Owen and Dr. Steitz also came up.
More examples
Dr. Ari Hyman, August 2023
Three months after a revision to correct uneven nostrils. Shared as an example of strong derotation.
Sources
- Rohrich RJ, Afrooz PN. Revisiting the Alar-Columellar Relationship: Classification and Correction. Plast Reconstr Surg 2019;144(2):340–346. PubMed
Composite grafts
Take a small piece of your ear that has two layers, skin and the cartilage under it, and stitch it into the nose to replace what was cut.
Composite graft vs. cartilage graft
"Ear graft" can mean two different things. A cartilage graft is cartilage only: it can prop up or reshape a wing, but it adds no skin, so it can't undo an alarplasty on its own. A composite graft is skin plus cartilage (sometimes skin and fat). It's the only kind of graft that puts skin back. This section is about composite grafts.
A graft is like a cut flower in a vase. It has no roots, so it has to grow new blood vessels in its new spot. Small ones usually make it. Big ones sometimes don't.
| 2a. Internal | 2b. External | |
|---|---|---|
| Where it goes | Inside the nostril. The wing is freed and the graft is tucked into the lining. | On the outside of the wing, filling the wedge or sill that was cut. |
| What it can do | Modest extra size and a little flare. | The most direct way to rebuild the shape that was cut. |
| Scar you'd see | Only if someone looks up your nose. | On the outside, around the patch. |
| Main risk | Shrinking back over time. | Color mismatch, shrinking, not taking. |
| Can it be undone? | Easier to remove. | Hard. Removing it means more scars. |
Internal composite grafts
The middle groundThe wing is released from the inside, scar tissue is freed, and the composite graft is slipped into the nostril lining so the wing can sit further out. It doesn't rebuild the outside of the wedge, but it adds some size and flare without an outside scar. Many patients see it as the best balance.
Surgeons reported as doing it internally: Dr. Oguzhan Oguz, Dr. Shahriar Nazari (Iran), Dr. Blas García (Spain), Dr. Kidakorn Kiranantawat (Thailand), Dr. Ahmet Halit Aydın, and reportedly Dr. Khosh (US). Dr. Göde says he now only does them internally.
Key examples
Dr. Oguzhan Oguz
Rebuilding a lost nostril from the inside: before, at 1 month and at 7 months. It appears to have healed well. He posted the same case again in April 2026 as a video.
Dr. Kidakorn Kiranantawat (Thailand), 2024
Severe nostril narrowing after cosmetic surgery, fixed with a composite graft from the ear. Shown 1 year and 10 months later.
Dr. Sercan Göde
"Larger and better nostrils are possible." Rib cartilage plus composite grafts, on darker skin.
More internal examples 3 more
Dr. Ahmet Halit Aydın, May 2024
A complicated ethnic revision with a composite graft on one side. One of very few published examples on a Black patient.
Dr. Shahriar Nazari (Iran)
From his Instagram stories, tagged "alar expansion". His captions read "nasal reconstruction and enlarging the nasal ala".
Dr. Sercan Göde, 2024
An alar retraction repair. One patient recalls this case differently, as outside grafts that scarred, so ask him directly.
External composite grafts
Works, but showsThe composite graft is sewn into the outside of the wing, right where the wedge or sill was cut. It's the most direct way to rebuild the original shape, and it has decades of studies behind it. The catch is the outside scar, and ear skin doesn't always match nose skin, especially on darker skin.
Surgeons reported as doing it externally: Dr. Jason Roostaeian (US), Dr. Amir Sazgar (Iran), Dr. Shingyochi (Japan), Dr. Erkan Soylu, Dr. Fatullayev, and Dr. Ali Manafi (in his published study).
Key examples
Dr. Jason Roostaeian (US)
"Correcting the over-resected alar base." These appear to have healed well, with visibly bigger nostrils.
Dr. Amir Sazgar (Tehran), October 2026
One month after rebuilding a nose with six failed surgeries and past skin death. Too early to judge the scars.
More external examples 1 more
Dr. Shingyochi (Japan), February 2026
A difficult alar revision. You can see the old alarplasty scars at the base of the nostrils.
Skin tone matters
Ear skin can heal lighter or darker than the skin around it, and scars hold less pigment. On darker skin that's easier to see. Patients have reported external composites healing badly on Black and East Asian skin, and Dr. Toriumi reportedly told a Black patient: "if you were Caucasian, I would consider, but as a black person, I wouldn't recommend it." The studies are mixed, and there's almost no data for the darkest skin types. If you have darker skin, ask to see healed results on people with your skin tone, and lean towards internal.
Bottom line. If you want more size and can live with modest gains, an internal composite graft is the middle ground. External grafts rebuild the most, but the patch can show. Either way, grafts can shrink back over time.
More detail What surgeons said, research, figures, sources
What surgeons told patients
- Dr. Oguzhan Oguz (Istanbul, August 2026) told a patient he'd only do internal grafts, never external, and advised against external flaps too. Another patient said he suggested external for her, so ask directly.
- Dr. Sercan Göde said he used to do many composite grafts but now prefers flaps, because grafts must grow a new blood supply and can shrink.
- Dr. Erkan Soylu turned down one patient because he only does it when the nostrils are very small. Another patient reportedly widened successfully with him.
- Dr. Ziad Katrib uses internal grafts for pulled-up rims but turned down alarplasty repair.
What the research says
Composite grafts have the most evidence of anything here, though most studies are about injuries, burns and cancer rather than cosmetic alarplasty.
Manafi et al., 2013 (Iran)
- 56 patients, mostly after too much alar base was cut
- Small grafts (skin and fat): 47 of 47 took
- Bigger grafts with cartilage: 5 of 9 excellent, 3 acceptable, 1 failed
- Not advised over 2 cm. Use flaps instead
Toriumi et al., 2023 (US)
- 367 grafts in 234 rhinoplasties
- 93.7% took fully, 6.3% partly or fully failed
Sazgar et al., 2025 (Iran)
- 45 people with over-cut nostril floor and wing junctions
- No graft failures, even after past skin death
- Breathing and appearance scores improved a lot
Asian patients, 2026
- 15 patients, grafts placed from inside the nostril
- Mild shrinking and color mismatch at 3 to 6 months
- Scars "almost indistinguishable" at 1 year; 87% satisfied
Ahuja et al., 2014 (India)
- 19 patients, all survived, all shrank a little
- Pigment varied, like a skin graft
- Keep grafts under 1 cm wide
Agrawal et al., 2025 (India)
- 11 patients, skin types III to V
- Over 90% survival, one shrank by about half
A fresh composite graft can look pale, then bluish around day 7, before it pinks up as blood vessels grow in (Jackson and Reisler, 2018). Ask your surgeon what to watch for.
Sources
- Manafi A, et al. Can We Add Auricular Composite Graft to Our Rhinoplasty Armamentarium? World J Plast Surg 2013;2(1):33–40. Full text
- Toriumi DM, et al. Auricular Composite Graft Survival in Rhinoplasty. Facial Plast Surg Aesthet Med 2023;25(1):6–15. DOI
- Sazgar AA, et al. Single-Stage Alar Nostril Ring Correction Using Auricular Composite Grafts. Aesthet Surg J 2025;45(3):255–263. PubMed
- Auricular composite tissue graft for the correction of alar rim defect in Asian patients. Front Med 2026;12:1710063. Full text
- Ahuja RB, et al. Securing aesthetic outcomes for composite grafts to alar margin and columellar defects. Indian J Plast Surg 2014;47(3):333–339. Full text
- Agrawal KS, et al. Auricular Composite Grafts in Fitzpatrick Type III–V Indian Noses. Aesthetic Plast Surg 2025;49(9):2338–2349. PubMed
- Jackson SM, Reisler T. Alar Rim Notching Reconstruction With Auricular Composite Chondrocutaneous Graft. Eplasty 2018;18:ic25. Full text
Flaps
Move nearby skin into the nostril without ever cutting it off from its blood supply.
The trade-off: you need spare skin nearby, you make a new cut where it comes from, and small flaps can shrink unless cartilage holds them in shape.
Alar lobule island flap
Gentlest optionFixes shape, not sizeA tiny crescent of spare skin from the outside of the same nostril wing is moved into the notch, usually with a curved piece of ear cartilage to round out the wing. It uses tissue you already have and keeps the scar in the crease. You need a little spare skin on the outer wing for it to work.
Like rearranging furniture instead of building a new room. Nothing new comes in, so the nostril doesn't get bigger, but everything sits in a nicer shape.
Where: Dr. Norihiro Ohba, Primo Azabujuban Clinic, Tokyo. Dr. Göde and Dr. Tolga Bilece have also offered it to patients.
More detail The study, more figures, practical notes
The study (Ohba et al., 2024)
- 16 patients, 2016 to 2022, all after cosmetic nostril reduction
- Main tool: curved ear cartilage, chosen to avoid the color problems of composite grafts
- Flap added only when there was spare outer wing skin, 2 to 3.5 mm wide at most
Results
- Every flap survived
- Nostril shape improved in every case
- 1 cartilage graft got infected and was removed
- Typical follow-up about 9 months; retainer worn 6 months
Good to know
- To widen, the authors release a ligament and use cartilage to push the wings outward
- Small study, run by the clinic's own surgeons
- It needs cartilage support, or the groove can flatten
For tight scars and tethering next to the wings, patients have also recommended the Japanese surgeon @tetuichiro, though he wasn't taking overseas patients when asked.
Source
- Ohba N, Haraoka G, Ohba M, Takahashi N. Treatment of Alar Deformity After Cosmetic Surgery. Plast Reconstr Surg Glob Open 2024;12(11):e6327. Full text
Lip or cheek island flap
Promising, unprovenThe only option that adds living skinA small island of new skin from the upper lip or cheek is moved into the nostril while still attached to a stem of blood vessels, so the wing can be pushed back out. Dr. Sercan Göde (Izmir) is the surgeon best known for it. It works well for rebuilding columellas, and he started using it for alarplasty reversal in 2026.
Like moving a garden hose to another plant without ever unplugging it from the tap.
Why it's promising
- The only option that brings new living skin, so in theory the most size
- Can't die like a graft
- Nearby skin usually matches better than ear skin
Reasons for caution
- Very new for alarplasty. Most photos are from the operating table
- One patient who spoke to 20+ lip flap patients says their bases narrowed again within weeks
- Skin-only flaps can shrink and flatten the sills
- Some patients got clear scars on the sill or lip
Key examples
Dr. Sercan Göde, September 2026
"Alar base reversing by local island flaps." Taken on the operating table, so expect it to settle.
Dr. Sercan Göde, October 2026
One year after a complex revision with flaps. The early scars looked rough. One of the few one-year results available.
Dr. Sercan Göde
"Alar base reduction reversal." A lip island flap case, before and after.
More detail How it works, what surgeons said, research, 7 more examples
How it was explained to a patient
The surgeon cuts along the crease, keeps that skin attached, and turns it in to make a new sill, which lets the wing move outward. Cartilage or an internal graft goes underneath for support. Dr. Göde told a patient he'd turn a lip flap toward the wing rim to add width. He also said he hadn't done it on a Black patient yet.
What other surgeons said
- Dr. Oguz: he's done cheek (nasolabial) flaps for cancer patients and the scars look bad; flaps are too much just for flare.
- A US surgeon: does flap reconstruction often for cancer patients but would never recommend it for cosmetic patients; his note called flap rotations for alarplasty "very risky."
What doctors have published
No study has tested lip island flaps for cosmetic alarplasty reversal yet, but the building blocks exist:
- Patel et al., 2022: a flap from the crease moved a pulled-in nostril base outward in 5 patients, with a rim graft for support.
- Nadjmi et al., 2022: rebuilt a damaged wing with a flap from the opposite nostril base, with matching color.
- Selçuk et al., 2012: cheek flaps with cartilage support for wing defects. Manafi points to flaps like these for defects over 2 cm.
- Le Diep Linh et al., 2024: upper lip island flaps to rebuild columellas.
More examples
Dr. Sercan Göde, March 2026
A complicated revision with flaps. The video has close-ups of the scars, and opinions differ on how visible they are.
Dr. Sercan Göde, April 2026
Five months after a complex revision. Patients who reviewed it found the scars noticeable even with a filter.
Dr. Sercan Göde, January 2026
Tip and columella skin death, two months after reconstruction. Shared to show how his flaps work.
Dr. Sercan Göde
A revision that lengthened the columella and improved retraction. An island flap appears to have been used.
Dr. Sercan Göde, March 2025
An alar retraction repair. Some patients noticed teardrop notches afterwards.
Dr. Oguzhan Oguz, June 2026
"When tissue is lost, reconstruction becomes the only option." Patients have felt his flaps were less refined than Göde's.
Dr. Sercan Göde, March 2026
An extreme revision on a Black patient after skin death. A very severe case, and the scars are visible.
Sources
- Patel N, et al. Inferiorly Based Alar Groove Flap for Correction of Alar Base Malposition and Nasal Stenosis. Plast Reconstr Surg Glob Open 2022;10:e4334. Full text
- Nadjmi N, et al. A Novel Technique for Nasal Alar Reconstruction. Plast Reconstr Surg Glob Open 2022;10:e4284. Full text
- Selçuk CT, et al. Reconstruction of Full-Thickness Nasal Alar Defects Using Cartilage-Supported Nonfolded Nasolabial Flaps. J Craniofac Surg 2012. Abstract
- Le Diep Linh, et al. The Reconstruction of the Nasal Columella Defect Using Domino Flaps. Arch Plast Surg 2024;51(4):367–371. Full text
Bottom line. For notches with spare wing skin, the alar lobule flap with cartilage is the safest option so far. Lip and cheek island flaps are the only real hope for lots of tissue, but there are almost no healed, long-term results yet. Many patients choose to try gentler fixes first and wait for more results.
Other options
- Fix the structure first. Pulled-up or collapsed wings can often be fixed with cartilage grafts before touching skin. One study improved pulled-up rims by about 2.7 mm on average, though heavy scarring limited some results.
- V-to-Y advancement. A small flap inside the nostril pushed outward, roughly 2 to 3 mm per side. Few surgeons offer it, and at least one botched case with outside scars has been reported.
- Scar release. Loosening tight scars, sometimes with a Z-shaped cut, can help with smiling, tightness and itching. It won't make nostrils wider.
- Scar care. Laser, dermabrasion, tretinoin and medical tattooing all helped some patients and not others. Dermabrasion carries pigment risk on darker skin.
- Wait for swelling to settle. Early on, nostrils can look smaller and stiffer than they'll end up.
More detail Examples, research to watch, sources
Dr. Ziad Katrib
Reinforcing a weak tip with rib cartilage. Structure before skin.
Dr. Shingyochi (Japan), March 2026
Fixing the scar and the shape around the nostril.
Research to watch
Verteporfin, a drug being studied for healing with less scarring (Dr. Michael Longaker's lab, Stanford), and lab-grown tissue that survives until it connects to blood vessels (EU research project). Neither is available as a treatment yet.
Sources
Before you book
Questions to ask any surgeon
- Is my problem rotation, a pulled-up rim, weak cartilage, or missing skin? Each has a different fix.
- Can I see results a year or more after surgery, not on the operating table? Grafts and flaps have been reported to shrink back within weeks.
- Have you done this on someone with my skin tone? Can I talk to them?
- Will the graft or flap go inside or outside? Where will every scar be?
- What will hold the new shape? Ask whether cartilage support is part of the plan.
- Which stitches will you use outside, and when do they come out? Facial stitches usually come out around day 7.
- What's your plan for scar care afterwards?
- Exactly how many millimeters will you add or remove, and will it be in my report?
- If I don't like it, can it be undone?
- Will you do anything I haven't agreed to in writing? Some patients have woken up with an alarplasty they never asked for.
Everything in one place
Sources and links
All studies and examples from this page. Personal accounts and anything not about repair are left out.
Studies 15
- Ohba N, et al. Treatment of Alar Deformity After Cosmetic Surgery. PRS Global Open 2024. Full text
- Manafi A, et al. Can We Add Auricular Composite Graft to Our Rhinoplasty Armamentarium? World J Plast Surg 2013. Full text
- Toriumi DM, et al. Auricular Composite Graft Survival in Rhinoplasty. Facial Plast Surg Aesthet Med 2023. DOI
- Sazgar AA, et al. Single-Stage Alar Nostril Ring Correction Using Auricular Composite Grafts. Aesthet Surg J 2025. PubMed
- Auricular composite tissue graft for alar rim defect in Asian patients. Front Med 2026. Full text
- Ahuja RB, et al. Composite grafts to alar margin and columellar defects. Indian J Plast Surg 2014. Full text
- Agrawal KS, et al. Auricular Composite Grafts in Fitzpatrick Type III–V Indian Noses. Aesthetic Plast Surg 2025. PubMed
- Jackson SM, Reisler T. Alar Rim Notching Reconstruction With Auricular Composite Graft. Eplasty 2018. Full text
- Patel N, et al. Inferiorly Based Alar Groove Flap for Alar Base Malposition. PRS Global Open 2022. Full text
- Nadjmi N, et al. A Novel Technique for Nasal Alar Reconstruction. PRS Global Open 2022. Full text
- Selçuk CT, et al. Full-Thickness Alar Defects With Cartilage-Supported Nasolabial Flaps. J Craniofac Surg 2012. Abstract
- Le Diep Linh, et al. Reconstruction of the Nasal Columella Using Domino Flaps. Arch Plast Surg 2024. Full text
- Marianetti TM, et al. Correction of Alar Rim Retraction by Lateral Crural Extension Graft. 2020. Full text
- Rohrich RJ, Afrooz PN. Revisiting the Alar-Columellar Relationship. Plast Reconstr Surg 2019. PubMed
- Randall NR, et al. Correction and prevention of tip asymmetries, bossae, and alar retraction. Plast Aesthet Res 2024. Full text
Instagram examples by method 26 posts
1. Derotation
- Dr. Sam Most, June 2023
A long-term revision result. The nostrils look fuller after derotation. This patient never had an alarplasty. Video, so play it on Instagram.
- Dr. Ari Hyman, August 2025
Seven months after a revision to bring down an upturned tip.
- Dr. Ari Hyman, August 2023
Three months after a revision to correct uneven nostrils. Shared as an example of strong derotation.
2a. Internal composite grafts
- Dr. Oguzhan Oguz Internal (April 2026 video)
Rebuilding a lost nostril from the inside: before, at 1 month and at 7 months. It appears to have healed well. He posted the same case again in April 2026 as a video.
- Dr. Kidakorn Kiranantawat (Thailand), 2024 Internal
Severe nostril narrowing after cosmetic surgery, fixed with a composite graft from the ear. Shown 1 year and 10 months later.
- Dr. Sercan Göde Internal
"Larger and better nostrils are possible." Rib cartilage plus composite grafts, on darker skin.
- Dr. Ahmet Halit Aydın, May 2024 Internal
A complicated ethnic revision with a composite graft on one side. One of very few published examples on a Black patient.
- Dr. Shahriar Nazari (Iran) Internal
From his Instagram stories, tagged "alar expansion". His captions read "nasal reconstruction and enlarging the nasal ala".
- Dr. Sercan Göde, 2024 Internal
An alar retraction repair. One patient recalls this case differently, as outside grafts that scarred, so ask him directly.
2b. External composite grafts
- Dr. Jason Roostaeian (US) External
"Correcting the over-resected alar base." These appear to have healed well, with visibly bigger nostrils.
- Dr. Amir Sazgar (Tehran), October 2026 External (His Instagram)
One month after rebuilding a nose with six failed surgeries and past skin death. Too early to judge the scars.
- Dr. Shingyochi (Japan), February 2026 External (A 2025 case, His Instagram)
A difficult alar revision. You can see the old alarplasty scars at the base of the nostrils.
3b. Lip and cheek island flaps
- Dr. Sercan Göde, September 2026
"Alar base reversing by local island flaps." Taken on the operating table, so expect it to settle.
- Dr. Sercan Göde, October 2026
One year after a complex revision with flaps. The early scars looked rough. One of the few one-year results available.
- Dr. Sercan Göde
"Alar base reduction reversal." A lip island flap case, before and after.
- Dr. Sercan Göde, March 2026
A complicated revision with flaps. The video has close-ups of the scars, and opinions differ on how visible they are.
- Dr. Sercan Göde, April 2026
Five months after a complex revision. Patients who reviewed it found the scars noticeable even with a filter.
- Dr. Sercan Göde, January 2026
Tip and columella skin death, two months after reconstruction. Shared to show how his flaps work.
- Dr. Sercan Göde
A revision that lengthened the columella and improved retraction. An island flap appears to have been used.
- Dr. Sercan Göde, March 2025
An alar retraction repair. Some patients noticed teardrop notches afterwards.
- Dr. Oguzhan Oguz, June 2026
"When tissue is lost, reconstruction becomes the only option." Patients have felt his flaps were less refined than Göde's.
- Dr. Sercan Göde, March 2026
An extreme revision on a Black patient after skin death. A very severe case, and the scars are visible.
4. Other
- Dr. Tolga Bilece, November 2025
A conservative alarplasty: only a thin sliver of outer skin removed, nostril size kept. On the operating table.
- Dr. Ziad Katrib
Reinforcing a weak tip with rib cartilage. Structure before skin.
- Dr. Shingyochi (Japan), March 2026
Fixing the scar and the shape around the nostril.
Surgeons and clinics mentioned As reported by patients
- Dr. Oguzhan Oguz
Istanbul. Internal composite grafts.
- Dr. Shahriar Nazari
Iran. Internal composite grafts ("alar expansion").
- Dr. Blas García
Spain. Internal composite grafts. Long waiting list.
- Dr. Jason Roostaeian
US. External composite grafts.
- Dr. Amir Sazgar
Tehran. External composite grafts; published a 45-patient study.
- Dr. Shingyochi
Japan. External composite grafts and alar revisions.
- Dr. Sercan Göde
Izmir. Lip and island flaps.
- Primo Azabujuban Clinic (Dr. Norihiro Ohba)
Tokyo. Alar lobule island flaps with ear cartilage.
- @tetuichiro
Japan. Scar and tethering revisions.
- Dr. Tolga Bilece
Turkey. Open to alar lobule flaps.
- Dr. Abdulkadir Göksel
Istanbul. Has used a lip flap technique.
- Dr. Frederick Menick
Pioneer of nasal flap reconstruction (retired). Useful reading on flap design.
- Scar clinic, South Korea
Shared for scar treatment research.
Word list What the doctor words mean
- Ala (alae)
- The nostril wing.
- Alar lobule
- The soft, rounded part of the wing near the bottom.
- Alar crease
- The groove where the wing meets your cheek.
- Sill
- The little floor at the bottom of each nostril.
- Columella
- The strip of skin between the nostrils.
- Alarplasty
- Surgery that cuts skin from the nostrils to make them smaller. Also called alar base reduction.
- Weir excision
- An alarplasty that cuts both the sill and a wedge from the wing.
- Flare
- How much the wings curve outward.
- Notching, teardrop deformity
- A dent in the nostril edge, or a nostril pulled into a teardrop shape.
- Retraction
- When the nostril rim is pulled up too high.
- Nostril show
- How much of the nostril openings you can see.
- Rotation, derotation
- Turning the nose tip up, or back down.
- SEG
- Septal extension graft. A strong cartilage piece that sets where the tip points.
- Cartilage graft
- Cartilage only. Adds support and shape, not skin.
- Composite graft
- Skin plus cartilage (or fat), moved as one piece. Adds skin.
- Flap
- Tissue moved while staying attached to its blood supply.
- Island flap
- A flap attached only by a small stem of blood vessels, so it can move further.
- Table photo
- A photo taken on the operating table. Results look better than they'll end up.
- Fitzpatrick type
- A scale from I (very fair) to VI (deeply pigmented). Matters for scars and pigment.