When Square Jaw Botox Did Not Work: A Year with No Change

Hello. This is Dr. Song Myung-seung of NUWA Clinic Gangnam, where we assess the concern before the treatment.

If you have found this article through a search, you are probably weighing up whether to have alar botox or the nose contouring injection to make your alae look smaller.

To give you the conclusion first: although both look like treatments for the same “nose”, the area they act on and the way they work are entirely different. That is why the right answer only emerges once you know why your own alae look wide. Today I will go through how to make the alae look smaller, divided by cause.

Alar botox is not a treatment that shaves the nose

Alar botox reduces the movement of the muscles that flare the alae, controlling the spread.

People often think that having alar botox makes the nose smaller as a whole, but alar botox is botulinum toxin. The alae have their own muscles that pull them outwards, and when these move while you smile or speak, the alae appear to spread. Alar botox works in the direction of easing how much the alae spread by reducing the movement of exactly these muscles.

When alar botox is a good fit

Alar botox suits cases where the reason the alae look wide is “muscle”.

Typically it suits those whose alae spread markedly when smiling or speaking. Those whose alar muscles are tense even at rest, leaving the alae slightly flared, also tend to see some response as the muscles relax. In other words, if the “movement” of the alae flaring is the heart of the concern, alar botox is the starting point.

How does the nose contouring injection differ from alar botox?

The nose contouring injection works directly on the soft tissue of the nose (fat and thickness) rather than muscle.

Using a product that breaks down and refines fat, it reduces unnecessary thickness at the nose tip and bridge, tidying the nose line itself into something slimmer. It therefore suits those whose nose tip looks blunt or thick even when they are not smiling. If alar botox addresses “movement”, you can understand the nose contouring injection as addressing “thickness”.

There are also cases where alar botox has no effect

If the reason the alae look wide is not muscle, change is hard to feel with alar botox.

This applies where the structure itself is wide, as with alar volume, cartilage or nostril size. Here, relaxing the muscle with botox leaves the structure as it was, so change is limited and another approach needs to be considered alongside. And if the cause is the thickness of the tip or bridge, that is the territory of the nose contouring injection, so alar botox alone will not change it. This is why some people say, “I had alar botox and nothing changed.”

How to make the alae look smaller: why does my nose look big?

The reasons the alae look big divide broadly into three, and how to make them look smaller differs according to the cause.

First, because of muscle movement. This is the case where things are fine at rest but the alae spread when smiling or speaking, and alar botox is the better fit.

Second, because of thickness. This is the case where the tip and bridge are simply thick regardless of movement, and refining the line with the nose contouring injection comes first.

Third, where the structure itself is wide. This is the case where alar cartilage, the nostrils or alar volume is the cause, and a direction other than injections may need to be looked at alongside.

In practice, most people have these causes mixed together, so it is not uncommon for a single treatment alone to leave the line only partly resolved.

Alar botox vs the nose contouring injection

Category	Alar Botox	Nose Contouring Injection
Main area	Alar muscles	Nose tip and bridge
How it works	Reduces muscle movement	Reduces thickness and volume
Good fit for	Alae spreading because of muscle	The nose line itself being thick
Limits	Limited where structure or thickness is the cause	Does not address muscle movement

Both being “nose” treatments makes them easy to confuse, but what they aim at is completely different. That is why looking at the cause first matters more than settling on a treatment name first.

Why I look at the cause before the treatment name

What we are most wary of is carrying out exactly the treatment a patient has arrived with in mind.

Even when someone says, “I would like alar botox,” I first look at whether those alae are down to muscle, to thickness or to structure. Looking together at the face at rest and while smiling in front of the mirror reveals which is the larger cause.

Simply doing the treatment that has been asked for is the easiest option from a doctor’s point of view. But a treatment that does not match the cause will not resolve the concern, however well it is carried out. All that remains is the disappointment of “this isn’t quite the feeling I wanted.” So I believe it is right to look at the cause first, rather than treat first.

A case from the clinic

There was a patient who came for alar botox, but on assessment the thickness of the nose tip turned out to be the larger cause.

For that patient I suggested refining the line with the nose contouring injection first, rather than botox. Had we proceeded with alar botox alone as originally requested, the change in the nose line that was actually wanted would have been hard to feel. This is why, with the same concern of “my alae look big,” the answer differs when the cause differs.

In closing

How to make the alae look smaller ultimately starts from “why do my alae look wide?”

If it is muscle, alar botox; if the nose is thick, the nose contouring injection; if the structure itself is wide, another direction needs to be looked at alongside. So assessing the cause comes before deciding on a treatment. If your alae or nose line are on your mind, I will look at the cause with you first.

This has been Song Myung-seung of NUWA Clinic Gangnam, where we assess facial shape concerns first. NUWA Clinic Gangnam is located directly in front of Exit 7 of Gangnam Station, on floors 3 and 4 at 385 Gangnam-daero, Seocho-gu, Seoul.

Frequently asked questions

Q. Can alar botox and the nose contouring injection be had together?

A. As the areas differ, there are cases where they are carried out together. That said, it is right to decide after first assessing whether your alae are a muscle issue or a thickness issue.

Q. How long does alar botox last?

A. With botox, muscle movement gradually returns over time. How long it is maintained differs individually, so we advise on this after assessment.

Q. I had alar botox but my alae are the same. Why is that?

A. If the reason the alae look wide is thickness or structure rather than muscle, alar botox will not change things much. This is why assessing the cause before treatment matters.

Q. Can the alae be made smaller without surgery?

A. If the cause is muscle or thickness, an injection-based approach is possible. That said, where the alar structure itself is wide, the change from a non-surgical treatment may be limited, so we advise on the direction after assessment.

*Treatment direction and results may differ according to the individual, and an accurate assessment is given through consultation at the clinic.