How can I change the size of my nostrils/make them smaller? They are very large and flared after my primary rhinoplasty (Photo)

Question

After my primary rhinoplasty my nostrils were left very large and wide, with lots of alar show. I just want anything that can change the shape or make them smaller as now they detract from the look of my whole nose. Please help!

Steven M. Denenberg, MD · Answer

Your nose is very strong in its forward projection from your face. The tip can be brought back closer to your face. We call that "de-projecting" the tip. 
The woman in the short video that I posted with this answer had the tip of her nose de-projected a significant amount in her rhinoplasty
Then, when a nose is de-projected, it tends to *look* longer, as if the tip had drooped. So it's important to elevate the tip.Those two changes would decrease the prominence of your tip. I think the alae look big because the tip is bigger than we want. If the tip comes back closer to the face, and moves up, the alae move out of the way some, too.
How *much* to elevate the tip, or deproject the nose? We figure that out with morphs, well before surgery. I'd love for you to see some excellent professionally-designed morphs of what could possibly be done with your nose. Morphs could also help you identify what's bothering you, and help you set a goal for the rhinoplasty that's accurate for your tastes. Profile and three-quarter views would be particularly important in morphing your nose. (Side note: in my opinion, morphs should always be done by the surgeon, or he should direct an assistant as she makes the morphs. Morphs should be made with a constant eye to what actually *can* be done in surgery, for that particular nose, and only the surgeon has that information and judgment. Another aside: I also recommend that you not show morphs made by one surgeon to a different surgeon. If a surgeon makes his *own* morphs, you get to see whether he understands the important issues of your nose, and how your nose should be changed. But if you show the surgeon someone else's morphs, and he says "Of course I can make your nose look like that," then you don't really know if he fully understands, or even recognizes, the important changes shown in those morphs. And you don't know if he can make those changes during surgery.)
Remember that rhinoplasty is an exquisitely difficult operation to get right, and you should only have surgery if you are able to make yourself very confident in your surgeon's skills. The changes that your nose needs require advanced techniques, and skill that most plastic surgeons don't possess with expertise. For most noses, it's much better to not have surgery than to have inexpertly-performed surgery. Read my essay on how to stay out of trouble while selecting a rhinoplasty surgeon. And for those who have had previous surgery, it also discusses how to tell whether your first surgeon should be performing your revision. And it also discusses how to take photos that are best for online evaluations.
Your nose is also a perfect example of why computer imaging by the operating surgeon is mandatory in rhinoplasty. You need to know exactly what the surgeon is planning to accomplish -- what features he thinks he can change, and by how much he thinks he can change them. I always email morphs to my online rhinoplasty consultations. When you see the surgeon's goals in the morphs, you'll know whether he has an eye for an attractive nose, and whether he shares your opinion of what constitutes an attractive nose. You'll also know whether the changes he proposes are large enough to be meaningful to you, and whether he understands your wishes enough to address all of your priorities. How would you ever get that figured out without the morphs?

Toby Mayer, MD · Answer

Treatment of wide ala and hanging columella and overprojected tip, etc. These can all be corrected by a VERY experienced revision rhinoplasty surgeon who does natural noses with many examples of his corrections in noses like yours.

Thomas A. Mustoe, MD, FACS · Answer

Bringing in the nostrils by resecting skin from the nostril floor is a straightforward procedure that can be done in the office with a very well hidden scar.  However, some of your flare and nostril show visible on lateral view is more complex to fix. You have a nice shape on lateral view, but the tip is projecting  significantly, and the nostril may have been pulled up somewhat by resection and removal of some of the tip cartilage.  I think your problem is actually pretty complex, and may require a full revision rhinoplasty to correct. I would consult more than one experienced revision rhinoplasty surgeon, and bring your preop pictures and operative note to assist in the evaluation.  Then you can full consider your options.

Jeffrey Jumaily, MD · Answer

Thank you for your questions and photos. Your nose tip is overprojected (too long and far from the face) in addition to hanging columella and wide alar base. You would benefit from addressing these issues with a revision rhinoplasty procedure. Consider a consultation with a rhinoplasty surgeon to discuss your options. Best wishes.Jeffrey Jumaily MDFacial Plastic Surgery - Los Angeles - Toronto

William Portuese, MD · Answer

An alar-plasty can accomplish narrowing wide nostrils.  This involves removal of a small wedge of skin at the base of the nostril to narrow them.  A columella-plasty is performed to reduce the hanging columella.  If the nose were de-projected in the tip some more, you get a little more flaring of the nostril certainly would not be quite as long, but this would only be very minimal.  Also important to wait at least 1 year after your primary rhinoplasty to perform any revisions.

How can I change the size of my nostrils/make them smaller? They are very large and flared after my primary rhinoplasty (Photo)

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