Excessive nasal flaring when smiling (after primary rhinoplasty) - could I benefit from alar base reduction? (Photo)

Question

I had primary rhinoplasty almost 2 years ago. I am happy with the way it looks in my side profile and when I am not smiling (in repose) - but dislike the amount of nasal flaring when I smile. Would I benefit from alar base reduction? or botox? I may consider revision rhinoplasty in 1-2 years but wanting to do something before my wedding in the next 6 months. Would having alar base reduction surgery have a negative impact in a potential future revision rhinoplasty procedure?

Manish H. Shah, MD, FACS · Answer

Hello,Thanks for your question. If you are concerned with post-operative nostril flaring with smiling, you do have a couple of options. An easy option to start with would be the use of Botox or Dysport to reduce the power of the muscles around the nose that contribute to nostril flare. The effect will only last 3-4 months so if you don't like it, you don't have to do it again. The downside is that it may make you smile more stiffly during that time. The other option is an alar base narrowing procedure. If you are at least 1 year after your initial rhinoplasty, it is safe to have the procedure performed in the office under local anesthesia. You will be healed in time for your wedding in 6 months as long as all goes as planned. If you like your profile and repose frontal views, I'm not sure what revision you would need at all. Revision surgery doesn't make sense. However, adding nasal base surgery isn't revision. It is just optimizing your current results. A properly performed alar base reduction procedure would not then complicate any future revision because you don't really need revision surgery at this point, just base reduction.Good luck,Dr. Shah

Thomas A. Mustoe, MD, FACS · Answer

Unfortunately nostrils will always flare when smiling.  An alar base resection may help slightly but you have to be careful to not construct the nostrils too much.  Your nose really looks very normal with a smile.

William Portuese, MD · Answer

An alar-base reduction procedure accomplishes narrowing the nostrils at rest. The nostrils will still widen when smiling due to the facial muscle attachments to the base of the nose.

Excessive nasal flaring when smiling (after primary rhinoplasty) - could I benefit from alar base reduction? (Photo)

Answers (3)

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