Some nose jobs I've seen seem to have included nicely done nostril reduction. Is there just one approach to achieve such result (which will require external incisions on both sides of the wedges), or are there more approaches?
Are There Any Approaches to Nostril Reduction?
Doctor Answers 22
Nostril reduction is a graduated approach
Nostril reduction is a graduated approach. In my opinion, nostril reduction involves a stepwise approach. For someone who has normal shaped nostrils and the entire nose is reduced, sometimes flaring or widening of the nostrils can occur. Often this can be treated with simple excision of some soft tissue in the area called the nostril sill which is the area between the nostril and septum/columella(column of nose). These scars are imperceptible. Next, if the nostrils tend to not only be wide but are significantly flared outward, the incision can include part of the nostril base on the inside aspect to bring it closer to the face and help some of the width of the nostril itself. Lastly, if the base of the nose is wide and the nostrils themselves are excessively flared, both procedures can be combined to reduce the size of the nostrils and alter their shape. Occasionally, if they are very wide and flared, an additional incision along the outside edges of the nostril may be required to free up the nostril and bring the whole complex closer toward the face.
Nasal width reductions are specific to each problem
Nasal width reduction is used for different problems and thus the techniques are different for the desired result.
Problem #1-Very wide base with poorly projecting tip. For this problem increasing tip projection along with medially placed wedge resection works well. The wedge resection is usually well hidden.
Problem #2 - Very wide base, poorly projecting tip and rounded nostrils. Same as problem #1, but with added excision inside the nostril to flatten out the rounded nostril.
Problem #3 -Wide base with normal projecting tip. Wedge excision to narrow and shape the nostrils.
Problem #4 Wide base or Normal base in patient with large projecting nose. When the projection of the nose is reduced, the nostrils will flare out, thus requiring an adjustment of length, width and shape. The wedge resection for this type of nose will involve the largest amount of resection as well as scarring.
Most importantly, regardless of the technique or problem treated, all wedge resections should NOT be in the crease between the nose and the cheek. Although this may sound like the best place to put the incision, it results in the worst scars. Have your doctor place the incision just above the crease - it heals much better.
Nostrils in Rhinoplasty Need to Be Customized
You pose a great question. Just like other parts of the nose (bridge, tip sidewalls), the nostrils need customized attention. There is no one way to perform anything artistic such as plastic surgery, especially rhinoplasty. Nostril shaping in rhinoplasty is highly specialized and commonly needed for ethnic patients. Your surgeon needs to evaluate the nostril aperture, the distance between the nostrils, the shape of the nostrils (round, oval, teardrop), the thickness of the actual nostril and rim, as well as the amount of nostril flaring and angulation. All this demands a meticulous eye and precise surgical delivery. Unfortunately, many surgeons so not give the nostrils enough attention. In general, a surgeon who operates on a diverse ethnic population will have more experience with thick skin and various ways to shape the nostrils to harmonize and balance with the rest of the nose. Many of the patients in the gallery link below and in the video gallery have had nostril shaping. Always look very closely at your potential surgeon's gallery and videos. There should be no views hidden. Patients should be shown with frontal, side and three quarter and sometimes bottom views to show the nose in its true form.
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The nose if very complex, but there are ways to reduce the nostrils
This is a good question.
People often enquire about nostril reduction. The anatomy of the nose is very complex and often by changing one aspect of the nose the others change as well. So, it is often best to approach the nose as a whole rather than doing "quick fixes" to just one part. For reducing the nostrils, what you describe is an alar base resection - this essentially involves wedging out the lateral parts of the nostril and sewing them back together. In this procedure the incision is hidden at the base of the nose where the nostril is attached to the face. This is a nice procedure and produces excellent results.
I hope this is helpful.
Nostril Reduction Surgery
Narrowing the nostrils
There are two techniques which are used for narrowing the nostrils during rhinoplasty: Weir excisions and Sill excisions.
The Weir excision is used for nostrils which are excessively flared. In this procedure, a portion of the nostril rim is excised where it meets the face.
The Sill Excision is indicated for patients who have an excessively wide base of the nose. In this procedure, a small wedge of tissue is resected in the nasal sill, between the edge of the nostril and the columella, the vertical band of skin and cartilage between the nostrils.
Both procedures can be very effective, as isolated procedures or in combination with other rhinoplasty techniques. The incisions typically heal very well and should be quite inconspicuous. The key to success is to use the procedures judiciously, as the results can be quite challenging to reverse.
For some patients, the underlying issue is a lack of nasal tip support, which causes the nostrils to widen and flare with smiling, as the tip droops. If this is the case, supporting the tip with placement of a columellar strut or septocolumellar suture may be more appropriate. A careful assessment of your nose during the rhinoplasty consultation will guide the surgeon as to whether either one of the above nostril-narrowing procedures is indicated.
Many approaches, but beware
There are several approaches to nostril narrowing, but beware, nostril narrowing can also cause difficulty breathing and may not be reversible. The often used aesthetic is from caucasians where the base of the nostrils should be as wide as the distance between the eyes. This varies by ethnicity of the patient though. Narrowing the nostril too much may cause significant breathing difficulty and will be very difficult if not impossible to correct.
No Cookie Cutter Approaches in Rhinoplasty
Nostril reduction, aka alar base reduction, is a highly complex procedure to make either the alar region or nostril region smaller. Once this procedure has been performed it is very difficult to reverse.
Just some insight into its complexity:
There are many ways to perform this procedure. The incision can be made at the corner of the nostril, on the outside, with an internal suture, etc. The nostril size can be decreased or left the same. The base of the nose can be decreased or left the same as well.
It is important to distinguish the width of the alar base from the flair. The flair is the portion of the nostril which gives it an extra curve to the nostril.
Nostril reduction can be performed with a rhinoplasty or by itself. Sometimes projecting the nose (sticking it out further to give more definition) can reduce the nostril flair and width, and a nostril reduction may not be necessary.
Many Techniques for Nostril Reduction
I agree with you that many rhinoplasties involve excellent nostril reduction. There are many different approaches depending on the type of nostril. Most importantly, the excision requires precise diagnosis, execution, and closure to prevent an obvious "surgical" appearance. Nostril reduction is considered when the lateral aspects of the nostril are outside of a striaght line dropped down from the inside corner of the eye. Be well.
Are There Any Approaches to Nostril Reduction?
Yes, there are multiple approaches to nostril reduction. Because of the complex and integrated structures of the nose, the nostrils will most likely even change shape with a rhinoplasty or septorhinoplasty, can be done as it's own nostril surgery, or in combination.
Garrett A. Wirth, MD, MS, FACS
Wirth Plastic Surgery
These answers are for educational purposes and should not be relied upon as a substitute for medical advice you may receive from your physician. If you have a medical emergency, please call 911. These answers do not constitute or initiate a patient/doctor relationship.