What can be done to fix my wide nose after orthognathic surgery (Lefort osteotomy)? (Photo)

It is not uncommon after a LeFort I osteotomy to have increased nostril width and puffier cheeks. This is due to the soft tissue midface degloving that needs to be done to access the bone to do the procedure. These muscular attachments are very hard to put back in their exact location on the bone and, as a result, the soft tissues are retracted a bit more laterally. Removing the metal hardware does not provide a solution for these concerns. What can be done is to do an intraoral V-Y soft tissue advancement with nostril narrowing after elevating the midface tissues to try and produce a medicalization of these tissue attachments. In do doing the metal plates and and screws can be removed as a matter of coincidental exposure.

Thanks for your question. What you are describing is not an uncommon phenomenon after a Lefort I advancement. When the mid face is advanced this can lead to widened of the base of the nose. Sometimes an alar cinching suture is placed with a permanent suture to prevent and counteract this splay that occurs. If an absorbable suture was used however, the results may not be permanent. That being said this is still something that can be fixed but it would be helpful to know the indication of the Lefort I surgery. Seeing a rhinoplasty specialist will help create a customized plane that will work best for you. Best, Dr. Ali

 The wide nose can be narrowed with a closed rhinoplasty approach with placement of all incisions on the inside of the nose. Osteotomies placed in the nasal bones accomplish  narrowing the entire upper two thirds of the bridge line, and a conservative cartridge removal or suture techniques can accomplish and narrowing the nasal bones.  Wide nostrils are narrowed with an alar-plasty.  For more information  and many before-and-after examples narrowing a wide nose with  closed rhinoplasty,  please see video below