There is excessive nostril show in this patient. This can be due to several reasons. The nose may be short or the nostrils are large. Correction requires 1 of 2 methods.Firstly, a composite graft (skin and underlyiong cartilage) can be harvested from the ear and placed in the nostril to reduce alar notching. Secondly for severe cases, an alar rotation flap is needed. This requires the entire alar to be mobilised and rotated inferiorly to reduce notching and excessive nostril show. This patient's excessive alar notching could only be adequately addressed using an alar rotation flap. This picture is taken 8 weeks after surgery, the scar will eventually lighten over the next six months and can usually only be observed on close inspection.