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What causes triangular nostrils after rhinoplasty? (photo)

I have noticed that in some rhinoplasty patients, the nostril opening changes from round to triangular, making the nose look very unnatural and operated (please see pics). This seems to happen more in thick-skinned ethnic noses such as asian or african american noses but sometimes in caucasian noses as well. Is this due to trip refinement or alarplasty or something else? How can it be avoided? And if it does occur, can it be fixed? Thank you.

Doctor Answers 6

Preventing Alar Notching in Ethnic Rhinoplasty

January 2nd, 2014
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With a lot of tip refinement/projection in thicker skinned noses, notching of the soft tissue triangle (what you call the triangular nostril) can occur due to an inherent tissue deficiency and scar contracture in an unsupported area of the nostril rim. This can be lessened by the placement of alar rim grafts or crushed cartilage grafts during closure in that area.

Web reference: http://www.eppleyplasticsurgery.com

Barry L. Eppley, MD, DMD
January 2nd, 2014

Preventing Alar Notching in Ethnic Rhinoplasty

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With a lot of tip refinement/projection in thicker skinned noses, notching of the soft tissue triangle (what you call the triangular nostril) can occur due to an inherent tissue deficiency and scar contracture in an unsupported area of the nostril rim. This can be lessened by the placement of alar rim grafts or crushed cartilage grafts during closure in that area.

Learn more: http://www.eppleyplasticsurgery.com

Barry L. Eppley, MD, DMD

Triangular Nostrils

January 3rd, 2014
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You are correct. Rhinoplasty with sculpting the lower lateral cartilages, elevation of the tip with a septal graft, elevation of the caudal septum, and a alarplasty can create a triangular appearance to the alar rims. It may be more noticeable in noses that are originally wide in the alar base like african american noses, asian noses, and non-caucasian noses. However, it is seen in caucasians as well.

Consult a Board Certified Plastic Surgeon

Best wishes
George C. Peck, Jr, MD

George C. Peck, Jr, MD
West Orange Plastic Surgeon
4.8 out of 5 stars 23 reviews

January 3rd, 2014

Triangular Nostrils

{{ voteCount >= 0 ? '+' + (voteCount + 1) : (voteCount + 1) }}
You are correct. Rhinoplasty with sculpting the lower lateral cartilages, elevation of the tip with a septal graft, elevation of the caudal septum, and a alarplasty can create a triangular appearance to the alar rims. It may be more noticeable in noses that are originally wide in the alar base like african american noses, asian noses, and non-caucasian noses. However, it is seen in caucasians as well.

Consult a Board Certified Plastic Surgeon

Best wishes
George C. Peck, Jr, MD

George C. Peck, Jr, MD
West Orange Plastic Surgeon
4.8 out of 5 stars 23 reviews

What causes triangular nostrils after rhinoplasty?

January 3rd, 2014
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Interesting question. Basically, it has to do with the anatomy of the lower lateral alar cartilages and the nostril rim... Best to seek in person explanations of the effect of rolling a triangular shape to an oval one-simple 3-D geometry.  

Darryl J. Blinski, MD
January 3rd, 2014

What causes triangular nostrils after rhinoplasty?

{{ voteCount >= 0 ? '+' + (voteCount + 1) : (voteCount + 1) }}

Interesting question. Basically, it has to do with the anatomy of the lower lateral alar cartilages and the nostril rim... Best to seek in person explanations of the effect of rolling a triangular shape to an oval one-simple 3-D geometry.  

Darryl J. Blinski, MD

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What causes triangular nostrils after rhinoplasty?

January 2nd, 2014
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The notching that appears after some rhinoplasty is the result of over resection of the lower lateral cartilages or movement of the lower lateral cartilages medially and upward. This deformity can be corrected with repositioning of the lower lateral cartilages or placement of cartilage graft for added support or both.
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Mohsen Tavoussi, MD, DO
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January 2nd, 2014

What causes triangular nostrils after rhinoplasty?

{{ voteCount >= 0 ? '+' + (voteCount + 1) : (voteCount + 1) }}
The notching that appears after some rhinoplasty is the result of over resection of the lower lateral cartilages or movement of the lower lateral cartilages medially and upward. This deformity can be corrected with repositioning of the lower lateral cartilages or placement of cartilage graft for added support or both.

Mohsen Tavoussi, MD, DO
Orange County Facial Plastic Surgeon

What causes triangular nostrils after rhinoplasty?

January 1st, 2014
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There are certainly technical issues that can produce this appearance.  There is only a certain amount of alar base reduction that can be achieved before nostril distortion can be an issue. 

Find a board certified plastic surgeon who performs hundreds of rhinoplasties and rhinoplasty revisions each year. Then look at the plastic surgeon's website before and after photo galleries to get a sense of who can deliver the results.

Kenneth Hughes, MD

Los Angeles, CA

Web reference: http://www.hughesplasticsurgery.com/Rhinoplasty.php

Kenneth B. Hughes, MD
January 1st, 2014

What causes triangular nostrils after rhinoplasty?

{{ voteCount >= 0 ? '+' + (voteCount + 1) : (voteCount + 1) }}
There are certainly technical issues that can produce this appearance.  There is only a certain amount of alar base reduction that can be achieved before nostril distortion can be an issue. 

Find a board certified plastic surgeon who performs hundreds of rhinoplasties and rhinoplasty revisions each year. Then look at the plastic surgeon's website before and after photo galleries to get a sense of who can deliver the results.

Kenneth Hughes, MD

Los Angeles, CA

Learn more: http://www.hughesplasticsurgery.com/Rhinoplasty.php

Kenneth B. Hughes, MD

Notched Nostrils

January 1st, 2014
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Notched nostrils is often a giveaway that rhinoplasty surgery has been performed.  It has to do with the skill of the surgeon and the techniques used in performing the rhinoplasty, not necessarily because of the goal of rhinoplasty (meaning it's not necessarily because of tip refinement or alar base reduction, etc)  If it does occur, it can be improved but it is difficult and there are limitations.  It is best to avoid it in the first place by seeking out a board certified specialist.

Web reference: http://www.kimberlyleemd.com/about-us

Kimberly Lee, MD

Kimberly Lee, MD
Beverly Hills Facial Plastic Surgeon
5.0 out of 5 stars 13 reviews

January 1st, 2014

Notched Nostrils

{{ voteCount >= 0 ? '+' + (voteCount + 1) : (voteCount + 1) }}
Notched nostrils is often a giveaway that rhinoplasty surgery has been performed.  It has to do with the skill of the surgeon and the techniques used in performing the rhinoplasty, not necessarily because of the goal of rhinoplasty (meaning it's not necessarily because of tip refinement or alar base reduction, etc)  If it does occur, it can be improved but it is difficult and there are limitations.  It is best to avoid it in the first place by seeking out a board certified specialist.

Learn more: http://www.kimberlyleemd.com/about-us

Kimberly Lee, MD

Kimberly Lee, MD
Beverly Hills Facial Plastic Surgeon
5.0 out of 5 stars 13 reviews

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.