Is it possible to make my nostrils smaller through rhinoplasty?

Question

I do not want a huge change eg to go to a very small button nose but have always hated my large open nostrils. I had rhinoplasty roughly 10 years ago - a bump on my bridge removed but the surgeon advised he couldn’t make the nostrils smaller since they were flared and he couldn’t add skin that was there. But I would like to get a second opinion. I would also like to ask if I would be suitable for a lip lift at the same time.

Lexie Wang, MD · Answer

Your surgeon was partially correct. When you have that degree of alar retraction, you do need additional skin order to bring the nostril notching downward. It is possible to do but it is not a commonly performed procedure so most likely your surgeon did not tell you about it, esp if it was something that that surgeon does not do. What you need are composite ear grafts to add both cartilage and skin to bring the notching down. You may also need an alar wedge resection but it's hard to tell from this view.  Good luck!

Tanveer Janjua, MD · Answer

Alarplasty will pull the nostrils down and inwards and that will help. Also, your columella is hanging and a columellar pull reduction (pull back) will help.
Alarplasty is a very fine and quick procedure that can narrow the nostrils and reduce the flare to soften the appearance. It has other names as well like ‘Weir Excisions’ or ‘Nostril Reduction’. It can be done under local anesthesia. The social down time is about a week. If you want to work from home you can start it the next day. For the procedure you are evaluated to determine how much of a change is needed. In the past surgeons had recommended 2mm to 5mm reduction. This was measured by drawing a vertical line at the lateral sides of the nostrils (alae). However, I prefer to use a mirror and Q-tips to show the patient how much of a change can be accomplished. Pushing with Q-tips from the sides can mimick the change. Patient can also pinch their upper lip near the base of the nose and will show them how much narrowing to expect. I try to quantify the change as small, medium and large. Rarely it can be extra large as well. I always advise the patients to be conservative in the change as it is an irreversible procedure. The procedure historically did not get a lot of attention in plastic surgery. It was always thought of an adjunct procedure done with a rhinoplasty. Historically most ethnic groups did not get rhinoplasties. Hence, the caucasian rhinoplasty was the main procedure that plastic surgeons were trained on. 15 years ago I started making videos on the procedure and putting them on YouTube. In my blogs I started using the term 'Alarplasty' as most doctors and patients were using the term nostril reduction or Weir Excisions. I started noticing that over years the term 'Alarplasty' became popular among patients as well. Today, most patients use the term freely and know a lot about the procedure. I am very excited to see this evolution over the years. My African American patients were especially happy to learn that you can make the nose look small without having to do a full rhinoplasty. Many of them noticed that every plastic surgeon they went to offered a full rhinoplasty. 
In summary, Alarplasty is a unique procedure in itself and hopefully more surgeons get trained in it and help more people.
You can visit our alarplasty website to learn all about it. 
Click on the video link below to see the details.
Regards
Dr. J

Eric M. Joseph, MD · Answer

Based on your single profile photo, you appear to have Stigmata of previous surgery. Your columella hangs too low, and your nostril margin is retracted upward. These two issues may be contributing to excessive nostril show. Since you have relatively thin nasal skin and would require cartilage grafting, the feasibility of surgery would require an examination, and the expertise of your surgeon is critical. Thank you for your question and I hope this is helpful. Sincerely, Dr Joseph

Richard G. Reish, MD, FACS · Answer

Hello and thank you for your question. Based on your photograph, you have severe alar retraction of your nostrils leading to over exposure of your nostrils. This can be addressed during a revision rhinoplasty with appropriate Re-tensioning of the tip and placement of alar contour grafts. I recommend that you seek consultation with a qualified board-certified plastic surgeon who can evaluate you in person.

Best wishes and good luck.

Richard G. Reish, M.D.
Harvard-trained plastic surgeon

Best wishes and good luck.

Richard G. Reish, M.D.
Harvard-trained plastic surgeon

Is it possible to make my nostrils smaller through rhinoplasty?

Answers (4)

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