My problem? Love my nose. But, only love it when I tense up the muscles near it! This has the effect of making it look thinner/more defined.--When relaxed, the nose looks wide. If I tense up, it pulls the nostrils in closer together while pulling them down slightly.-- How i can get my nose to look the way it does tense, when I'm relaxed. Dr. said, "Patients from India often want alar bases positioned lower to match the columellar show, not just narrowed." Anyone take a crack at this?
Very Unusual Alar Base Question/Dilemma. Who Can Figure This Out? (photo)
Doctor Answers 6
Alar Base Surgery To Reduce Nostril Sills
To surgically mimic the tensing of the base of your nose to narrow your alar base and therefore reduce the width of your nostril sills, I would use two permanent sutures, each a cerclage, from the base of each ala circling through the base of the upper lip. This was well described several years ago by Dr. Ron Gruber of Oakland, California.
Secondly, if I am understanding you correctly, you want to lower the position of the alar base, vis-a-vis the proximal portion of your columella. To do this, I would raise the proximal columella by resecting a small portion of the proximal caudal septum along with a small piece of proximal membranous septum. My point here is, since lowering the alar bases would be scarring and look unusual, and since it is a relationship thing, just raise the proximal caudal septum and associated membrane, and you get the same effect.
Dynamic alar base shaping
If you like your alar appearance when you tense the muscles near the alar, then you really have two different options. First you may consider using Botox to relax the counter muscles which can mimic when you are tensing the alar base muscles. Second, you can consider nasal base spanning suture to move the alar distance a little closer. You can also incorporate nasal sill base reduction to further lower your alar position. Because this involves dynamic anatomy, video would be much clearer. Of course best choice would be the in person consultation.
Stewart Wang, MD FACS
There are only two fundamental procedures for modifying the nasal base/alar width. One approach is an excision of skin from the nostrils, done in several ways, to narrow them and is best thought of as a static or resting procedure. The other approach is an internal suture technique that spans under the nasal base to cinch the nostrils inward and is best thought of as more of a preventative or dynamic procedure, meaning it prevents flaring during smiling animation. Based on your description you are describing changes that are best treated by a static approach through nostril base excision. Based on the skin cutout pattern along the nostrils, they can be brought both inward and downward.
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Alar base narrowing
It is possible to narrow the width of the nose with osteotomies and a tip plasty can also be performed to narrow the tip cartilages. Rhinoplasty is performed when the nose is static and not for dynamic reasons with the exception of releasing the depressor septi ligament.
Arriving the nostril base is a common procedure called alar wedge excision. It involves removing a crescent of skin from the nostril with the scar hidden in the nostril crease. It is an simple and standard procedure and sounds like it would accomplish what you desire. Good luck!
Alar bases too wide: rhinoplasty?
Your request is very common. Alar base narrowing, with or without adjusting columellar show, is a straightforward part of the rhinoplasty surgeon's tool set.
See a Board Certified Plastic Surgeon who has had a lot of experience with rhinoplasty, and be sure to see a complete portfolio of pre- and post-op pictures so you can see what types of results are reasonable. In rhinoplasty, more than for many other types of procedures, surgeon experience is very important.