Procedure for Nose That Widens with Smile?

In the course of performing an alar base procedure, many surgeons incorporate an alar cinching suture that restricts lateral movement of the nostril with smiling. Patients may even complain that they are aware of this tightness when smiling after surgery. The long term benefits of this suture are questionable.
Botulinum Toxin preparations in the nasal muscles may help but is of temporary benefit. It may drop your upper lip slightly as well.
Thinning of the skin must be done judiciously because it can compromise the blood supply and cause problems with healing. Steroids will also thin the skin but are discuouraged.

It’s normal for the nose to widen when patients smile. This
occurs because several of the muscles of facial animation insert into the
nostril rim.These muscles contract
whenever patients smile and this results in spread of the nose.Although
alar cinch procedures can narrow the nasal base width, smiling will still cause
spread of the nose. For this reason, nasal spread is something that should probably
be accepted as part of normal facial animation.The
nasal skin can be thinned during rhinoplasty surgery, but most surgeons feel
that this is a relatively risky maneuver. Thinning the nasal skin can result in
skin necrosis, scarring and poor aesthetic results. For this reason, it’s
generally not recommended to thin the skin at the time of rhinoplasty surgery.

Nasal widening with smiling is very common. Typically, this is the result of activity of the nasal alar or dilator alar muscles. It can be more profound in people with widened alar bases or nostrils to begin with. Certainly, narrowing the alar base can reduce the width of the nostrils and may also make it more static when smiling if the resultant narrowing disrupts the muscles that cause the widening to begin with. To thin the skin of the nose can be done but should be approached with trepidation since overly agressive skin thinning or debulking of the dermal fat can result in skin necrosis and loss vis a vis the "Michael Jackson" effect. I hope this information helps.

It is difficult if not impossible to keep the base of the nose from moving when you smile, and so I wouldn't set this as one of your goals for surgery. However, there is a natural balance between the width of the nose and the width of the mouth when your face is resting (no movement). Some folks have noses that are wider that this ideal, and so it throws off the balance of their central face. Reducing the width of the alar base can narrow the base of the nose and improve this balance, but this is really only seen at rest, not with motion.
In terms of surgically thinning the skin of the nose, I personally think this is difficult to do and even risky to do at the time of surgery. What I will do in some patients in do an injection of Kenalog (a steroid) into the skin several weeks after the procedure-- this steroid will reduce the inflammation and soften the skin a bit, and is a safer approach in my opinion.
Hope that helps,
Dr. Salemy

Hi and thanks for your question. All procedures that narrow the nostrils will reduce widening upon animation but none will completely eliminate this as no operation affects the facial muscles which are responsible for widening or flaring of the nostrils. See a board certified plastic surgeon experienced in rhinoplasty who can address your concerns in a consultation. Best of luck!