What is done during a rhinoplasty to correct large asymmetrical nostrils and an overprojected nasal tip?

I don't like my nostrils as they are too big and are also asymmetrical. I also have what I think to be an overprojected tip. I want to make my nostrils a little smaller and shorten the nasal tip. Is this a pretty common complaint of rhinoplasty patients? And how are these two things achieved? Thank you.

Doctor Answers 7

Alar plasty and tip plasty

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

These are the 2 most common procedures performed on the nose.  Alar plasty narrows the wide nostrils and can be used to make them more symmetric as well.  Please note that it is impossible to make them exactly the same even in the best of hands.  The tip plasty was narrow and define the tip better.  Both procedures can be done at the same time and in certain cases can be done under local anesthesia.


Dr. J

Bedminster Facial Plastic Surgeon
5.0 out of 5 stars 126 reviews

Deprojecting a nose

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

The middle crura (not medial crura) of a very projecting nose are usually the offending problem. They are too long. They can be cut back. 

When this is done, the nasal base may widen. so a Weir excision can be performed as needed.

This can be done, using closed technique.

Dennis Barek, MD (retired)
Great Neck Plastic Surgeon

Correcting a projecting nose: first look at the surgeon's before and after photos.

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

Deprojecting a nose is a change that requires advanced work on the tip cartilages, work that most plastic surgeons cannot accomplish with expertise. You must see the surgeon's before and after photos to determine whether he has the skill to deproject your nose -- whether he has successfully done it for other patients.

When the forward projection of the nose is lessened, the front-to-back length of the nostrils usually decreases at the same time, so the two changes go hand in hand.

See the "Web reference" link, just below my response. It contains an important section on how to stay out of trouble while searching for a rhinoplasty surgeon.

A projecting nose is also a good example of why computer imaging 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. When you see his goals, you'll know whether he has an eye for a beautiful nose, and whether he shares your opinion of what constitutes a beautiful nose. You'll also know whether the changes he proposes are enough to be meaningful to you, and whether he understands your wishes enough to address all of your priorities. But remember, you're not hiring him for his skills with the computer. The doctor must then show you his before and after photos to prove that he can actually accomplish what he draws on the computer.

I usually make a morph when I'm answering questions like this, but you didn't submit photos. At the *very* bottom of the Web reference page is a link to instructions on taking photos that are most useful for online consultations like this.

Steven M. Denenberg, MD
Omaha Facial Plastic Surgeon
4.8 out of 5 stars 42 reviews

What is done during a rhinoplasty to correct large asymmetrical nostrils and an overprojected nasal tip?

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

There are different kinds of rhinoplasty operations however we can divide them as the one that requires bone excision and the one that does not need bone excision. The main fact that we classify the rhinoplasty operations like that is that the results and postoperative period is associated closely with this fact. In the operations like “nasal tip correction”, “simple rhinoplasty” there is no need for a bone excision however these minor operations cannot be beneficial for everyone. The operation type is need to be determined by the surgeon according to needs of the patient. In these minor operations the rhinoplasty is performed with closed method. The bone and the cartilage tissues are not involved in the surgery directly. Small nasal bumps can be removed in these operations.

In the operation that needs the bone and cartilage tissues to be involved; open approach is used. In the procedures with open approach, the size, shape and functionality of the nose can be improved. The big nasal bumps can be removed and septal deviations can be corrected providing a better nasal airway

Bulent Cihantimur, MD
Turkey Plastic Surgeon
4.8 out of 5 stars 102 reviews

Nasal tip deprojection

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

Hello and thank you for your question. Based on your description, you may benefit from a nasal tip deprojection.  Make sure you specifically look at before and after pictures of real patients who have had this surgery performed by your surgeon and not just a computer animation system.  If you don't see tip deprojection  pictures, I would ask to see before committing to surgery.  The most important aspect is to find a surgeon you are comfortable with. 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

Richard G. Reish, MD
New York Plastic Surgeon
5.0 out of 5 stars 172 reviews

Rhinoplasty maneuvers

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

Yes, those are very common complaints of people seeking a rhinoplasty. There are many different maneuvers described to decrease tip projection. Alar base reduction is used to reduce nostril size and/or alar flare, and can be customized to reduce asymmetry. Make sure you consult with a rhinoplasty specialist to get started. Good luck!

Justin Cohen, MD
Washington DC Otolaryngologist


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

Thank you for your question.

Yes, nasal tip refinement and nostril reduction are common procedures performed for rhinoplasty patients. A tip rhinoplasty which includes trimming the lower lateral cartilages and placing precision sutures to refine the tip and make it look more pleasing and proportional to the rest of your face. An alarplasty is the technique that is commonly used for nostril reduction and this procedure consists of making an incision on the inside or outside of the nostrils then removing a specific amount of tissue. I hope this helps. Best of luck in your endeavors!

James Fernau, MD, FACS
Board Certified ENT
Board Certified Plastic Surgery
Member of ASPS, ASAPS, ISAPS, The Rhinoplasty Society, AAFPRS, OTO/HNS, ASLMS, International Federation for Adipose Therapeutics & Science

James Fernau, MD, FACS
Pittsburgh Plastic Surgeon
4.9 out of 5 stars 86 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.