Rhinoplasty Alternative for Broad Nose After Orthognathic Surgery?

Question

I had orthognathic surgery (leforte 1), 5 months ago to correct a gummy smile. The surgery has caused my nose to broaden at the base when I smile even though my doctor used an alar stitch. Is there anything that can be done to correct this other than Rhinoplasty?

Otto Joseph Placik, MD · Answer

There are a few considerations here. Is it wide at rest or with smiling?
If it is the former, you may benefit from an alar base resection along the nostril sill also termed a modified Weir excision. This can be combined with another alar cinching suture.
If the wide nose occurs with smiling, this can be softened with the use of Botox.
Discuss this with a plastic surgeon, as there may be other alternatives.

Toby Mayer, MD · Answer

Without a photo it is difficult to say. Narrowing the base is probably going to give you the desired result. This is a minor procedure, under local anesthesia and you could go to work the next day.

Eric M. Joseph, MD · Answer

You should consult a board-certified, experienced, Rhinoplasty surgeon to discuss your options. Narrowing the base of the nose is a fairly simple technique, that is usually performed at the time of Rhinoplasty when the alar base is wide.
I don't think there is a non-surgical alternative.
If you'd like to post / email me a full-facial photo, I'll be happy to share my thoughts.
I hope this helps, and best regards.

Darryl Coombes, FRCS(OMFS), FDSRCS(Eng) · Answer

This a complication of undergoing a maxillary impaction Le Fort procedure. Your surgeon has placed a Cinch suture in an attempt to narrow your alar base width- the truth is these do work and if anything are temporary.

	What should have been done at the time of the procedure was bony contouring of the priform aperture base. This could have minimised the alar base widening.

	A Rhinoplasty (not just excising excess skin) will be required to correct this problem now.

William Portuese, MD · Answer

A broad nose can be made narrower through osteotomies or rebreaking of the nasal bones.  The nasal tip can be made smaller through some tip suturing techniques as well.  Alar-based Wier excisions can be performed that reduce the alar bases.

Steven Wallach, MD · Answer

If your nose has widened after the LeFort I it is probably soft tissue. A revision of the alar cinch can be performed, but this is a surgical procedure. You may also have some residual swelling as well. It may be best to wait about 1 full year after your previous surgery before you go ahead for any secondary procedure.

Kenneth R. Francis, MD, FACS · Answer

MJR,
It sounds like your greatest problem is during animation, which leads me to believe that yours is a soft tissue concern rather than a bony one at this point.  Narrowing of your nostril base can be performed without a formal rhinoplasty, but it does still involve a surgical procedure.  Discuss your concerns with your orthognathic surgeon.  He/she undoubtedly has a relationship with a plastic surgeon or otolaryngologist for just such cases if he/she doesn't perform the base narrowing procedure themself.  Good luck!

Peter A. Aldea, MD · Answer

Dear MJR,
In a Lefort I impaction procedure a sliver of the maxillary bone under the nose is removed reducing the gum height and  its visibility allowing the upper lip curtain to only uncover tooth white instead of always revealing the gum too. After that narrow slice of bone is removed, the hard palate is fixed upward to the bone under the nose with small screw plates providing stable fixation.
An alar stitch attempts to narrow the base of the nostrils. However, if the bony foundation of the nose was widened in the process of impacting the maxilla, the middle and base of the nose will remain wide while the suture, rather ineffectively attempts to keep the forward looking nose appearance of the nostrils closer together - not always successfully.
The ONLY way the middle and base of the nose can be brought together and narrowed is surgically with a fracture of the lateral sides of the nose and bringing them together.
Hope this helped.

Richard W. Fleming, MD (retired) · Answer

You probably don't need a full rhinoplasty to improve your situation. Narrowing of the nasal base, which I suspect you need, is usually part of rhinoplasty surgery, but can be done as an isolated procedure. Ask for a referral to an experienced rhinoplasty surgeon.

Rhinoplasty Alternative for Broad Nose After Orthognathic Surgery?

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