Nostrils Flare After Rhinoplasty, How Can It Be Fixed? (photo)

Question

I had a rhinoplasty a year and a half ago and am not happy with the results. One of the many issues I have is my nostrils flare out now. I think it is from the tip being deprojected or the septum was lowered. How can I get my nostrils thinner and longer again?

Kenneth Hughes, MD · Answer

Given your explanation of what was done in the previous surgery, the likely solution would be to place a strut to help with projection. If the nose was deprojected and you dislike the loss in projection, this would be reasonable. However, if you like the deprojected look, the alar base can be altered to reduce the size of the nostrils but the nostrils will not be made longer with this maneuver. Kenneth Hughes, MD Los Angeles, CA

Catherine Winslow, MD · Answer

Hello! There are several ways to address nostril flaring after rhinoplasty, which certainly can occur when a deprojection is performed. Either narrowing the nostrils with a Weir excision, or cutting a portion of the alae to minimize flaring, is effective but requires a scar in the alar crease. Placing rim grafts- cartilage grafts just in the bottom of the alae- will also stiffen and straighten them to improve flaring. Find a rhinoplasty surgeon who specializes in revision and discuss your desires with them. Good luck!

Nabil Fanous, MD · Answer

Before any decision, I need you to send me a photo of your nose from the front and from the side (profile). If both OK, then a resection of the nasal base with a small scar will be recommended.

Michael L. Schwartz, MD · Answer

whenever there is significant deprojection and tip set back performed the nostrils will flare a little bit. If it detracts from you result then a alar base narrowing can be performed as a simple office procedure.

	good luck!

Sean Freeman, MD · Answer

I prefer not to alter the shape of the nostril at the time of the original rhinoplasty. I wait until the tip has settled and presented itself to the point that I feel comfortable taking this step. Why do I stage this? First of all it is not reversible so if one takes this step it must be done as precisely as possible. Secondly, when I change the projection, orientation and shape of the nasal tip it will change the shape of the nostril in a way that is unpredictable which harkens back to my first point. Finally it is a patient friendly step, can easily be done under straight local, with minimal bruising, swelling and post op discomfort. From your history and photos it looks like your nostrils flared after tip rotation/deprojection which as I stated isn't that uncommon. Should you like your tip position then alar rim surgery will fix the flaring. Good luck!

William Portuese, MD · Answer

Alar flaring after rhinoplasty can occur due to the de-projection of the tip. The simplest and easiest solution is to perform an alar-pasty and narrow the nostril base. This involves making a small incision at the nostril sill and a removing the appropriate amount of skin to narrow the base of the nostrils

Daniel Greenwald, MD (in memoriam) · Answer

After more than a year the results of your rhinoplasty are stable. Anything you don't like about your results should be discussed with your surgeon. from the limited photographic views it looks as though the nostrils are slightly flared, but the impact on the overall result is hard to appreciate. In general it is not impossible to revise this part of the nose. Sometimes narrowing of the base is helpful; sometimes small cartilage grafts are needed. If you have lost confidence in your previous surgeon make sure to see a Board Certified Plastic Surgeon who has a broad experience with revision rhinoplasty.

Richard W. Fleming, MD (retired) · Answer

It would be helpful to see pictures that show your entire nose but looking at the base the problem can be corrected by narrowing the nasal base and decreasing the flare of your nostrils. This is achieved with small incisions at the junction of your nostrils and the upper lip.

Nostrils Flare After Rhinoplasty, How Can It Be Fixed? (photo)

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