Is It Possible to Reduce Nostril Flare with Internal Excisions?

Question

Everytime I go to a consultation (in Houston, TX) and I ask doctors how they will address my nostrils they say "I will make incisions to the inside of your nose". I do not have a problem with sill excisions to decrease the width of my nose, but doctors never say anything about doing alar wedge excisions to address my flare! It's like they dont want to make any external cuts. Is it possible to reduce flare with internal excisions? If so, what technique is this??

Etai Funk, MD · Answer

Based on your photographs, it appears you have a widened base of the nose and wide cartilage. You would benefit from bringing in the base of the nose with wedge excisions. This does require incisions on the outside of the nose. However, with proper technique & placement along with meticulous closure, your scars should be nearly invisible. You would also benefit from refinement of your nasal tip and increasing the tip projection (which would also bring in the base).

Laurie A. Casas, MD, FACS · Answer

Flaring nostril can be successfully reduced by using techniques to hide scars internally at the base of  the nostril.

Toby Mayer, MD · Answer

The incisions on the inside reduces nostril flare and the scars heal well. I do not make them on the outside since these often heal poorly.

William Portuese, MD · Answer

The incisions for the alarplasty are at the base of the nostril sill, but are not completely inside the nose. They are a simple excision of skin including a portion of the nostril base and sill that is closed with fine meticulous sutures. This is also known as a weir alarplasty.

Robert Kotler, MD, FACS · Answer

Hello;

	You are correct about wondering about alar wedge excisions to address what you call the &ldquo;flare.&rdquo; 

	There is nothing improper about making an external incision because that has proven to be the most reliable and practical way to narrow the base of the nose when the &ldquo;sill&rdquo;--  or floor --  of the nostril is wide.

	It is a venerable technique that experienced nasal surgery specialists should be very comfortable performing. 

	If the doctor is not comfortable performing it, then perhaps you need to have further consultations with other plastic surgeons highly experienced in surgery of the nose.

	Robert Kotler, MD, FACS
	Author, SECRETS OF A BEVERLY HILLS COSMETIC SURGEON

Andrew Pichler, MD · Answer

Looking at your photos it appears that you need a full tip plasty to address other isues, such as bulkiness, of your tip. You'll also need tip support (i.e collumellar graft). Nostril flare can be addressed with insicons inside your nostril that heal very well. There are also burried permanent mattress suture techniques that can be placed into the lower later cartilages to effect narrowing of your nasal tip.

Donald T. Levine, MD · Answer

Yes. It is possible to reduce nostril flare and the lower 1/3 width of the nose with internally by excising a diamond shaped soft tissue beneath the collumella-upper lip area; and then by suturing the defect closed and thus converting the diamond defect into a straight line, the width of the nose decreases while at the same time increases the height of the nasal tip, and widens the naso-labial angle. Additional adjustments to equalize the width descrepancies of your nose would be necessary to improve and define your nose further. I always prefer to do before and after pictures prior to surgery (via email too) so that we would be more exact on your esthetic goals. In your case you may need alar base resections (direct excision) in order to maximize your cosmetic result

Barry L. Eppley, MD, DMD · Answer

To narrow wide nostrils such as your pictures show it is necessary to remove tissue. The debate as to whether incisions have to be made inside your nose or out is a matter of semantics and the extent of the incisions. So-called internal nostril narrowing incisions must cut through and place scars on some aspect of the skin of the nose skin, in this case the nostril sill. It does create an external scar but it is very small and vertical in nature. By removing a vertical wedge of sill skin it pulls in the nostril. An external nostril narrowing approach uses a similar vertical sill excision but extends it out to involve a horizontal resection of the side of the nostril as well. It is more effective at changing the nostril shape and does so at the price of a potentially more visible external scar. But if well done it ends up in the groove at the base of the nostril. Which nostril narrowing approach is better for you requires a good discussion as how much nostril narrowing and shape change is beneficial in the overall changes you want to achieve in your rhinoplasty.

Aaron Stone, MD · Answer

The base width of the tip can be wide because of horizontally oriented nostrils and/or thickened nostril rim. Your posted photos show the Afro-American or Asian type of nose with a wide base at the bottom, a round tip and a flattened bridge. Your nostril rim does not look thick. In my experience the best way to narrow the bottom of the base is to cut out a wedge from the outer corner of the nostril. That does not work if the incision is only inside the nose. To make the incision scar less visible a small flap of skin is left on the upper inner aspect of the wedge, the closure line of the wedge has to lied directly in the crease and the lower outer aspect of the wedge should stay within the shadow cast from direct overhead lighting. If you extend the lower outer edge of the wedge further it can be too visible.

	I hope you realize that this format of posting questions and receiving answers lacks the face to face direct communication required for you to make an informed decision regarding your surgery.

	My response to your question/post does not represent formal medical advice or constitute a doctor patient relationship. You need to consult with i.e. personally see a board certified plastic surgeon in order to receive a formal evaluation and develop a doctor patient relationship.

David A. Bray, Sr., MD · Answer

The external incisions usually heal well. But, nostril flaring can be reduced by interna nostril sill excisions with or without a cinching suture under the columella

Is It Possible to Reduce Nostril Flare with Internal Excisions?

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