Hello, I have a interesting question. I had septoplasty/rhinoplasty surgery about 16 months ago and I am bothered by my nostril show now. My nose before just had a little hump which I can still see a little. The bridge if my nose is not straight as it should. The tip was not changed which I requested because I felt my septum or middle hanging area was lower the my nostrils. The tip was never touched and now I have nostrils that looked pulled back a little. Like I'm mad all the time. Help :)
Can my Nostrils Be Lowered or Changed?
Doctor Answers 14
Excessive nostril show after rhinoplasty.
Overly visible nostril openings is a not uncommon complaint following rhinoplasty. The cause is usually due to upward rotation of the tip or inadequate resection of the columella in a patient who had borderline excessive nostril show before surgery. Alternatively, alar retraction due to scar formation pulling the nostril margin upward can also cause this. It is hard to say exact what has caused this in your case, however, the degree of deformity is luckily not very severe.
Correction can be achieved by resecting a strip of cartilage along the free edge of the septum at the columella and/or inserting a sliver-shaped cartilage graft into a pocket along the nostril margin (alar rim graft). It may be advisable to attack the problem from both ends and perform both maneuvers. Note, however, that alar rim grafts are a fussy technique and can alter the shape of the nostril margin, which in your case is nicely arched. It requires attention to detail to get it right. Both the columellar resection and the alar rim grafts can be performed using a closed rhinoplasty approach and the residual hump on your bridge can be further reduced through this approach as well.
Changing nostrils with Rhinoplasty or Revision Rhinoplasty
From your photos, it appears that you have what's called "columellar show" as a result of alar (tip lower edge) contraction or "notching" from your prior Rhinoplasty. The 'alar notching', typically occurs when to much tip cartilage is removed during a Rhinoplasty allowing the lower edge of the nostril to rotate up, creating a notch. This gives the illusion of the nostrils being rotated upwards.
"Columellar show" is a term given when the columella (front of the nose that meets the upper lip) appears elongated and the ditance between the base of the nose, where it meets the upper lip, is greater than 5mm's to the upper nostril. This usually happens when the nasal tip is over -rotated...or what patients describe as shortening the nose.
I have corrected both of these , let's call them, "post Rhinoplasty" irregularities. The columellar show can be corrected using a technique called "columellar tuck" that brings the columella back up under the nostrils making the distance within the aesthetically normal 3-5 mm's of columellar show. Sorry this is so technical but these issues are very technical and challenging to get right, so I want you to understand what will and will not fix them.
The alar notching is fixed using a wedge shaped, composite skin and ear cartilage graft that's placed in an incision along the notch just inside the nasal (nostril) rim. The graft allows the lower edge, of your nostril to come back down..removing the notch and over-rotated look to the nostrils.
Both of these revisions are minor procedures but you would, IMHO, need general anesthesia and a highly skilled Revision Rhinoplasty surgeon to perform them properly. These procedures take me about 1 hour to perform.
Alar retraction v.s droopy columella
Dear rhinoplasty patient,
It appears that you have a ptotic or droopy columella giving the appearance of an alar retraction. A simple procedure to correct your problem is to resect or remove the caudal (bottom) portion of your septal cartilage to lift the columella. This procedure will bring a harmony and balance in your nostril and columella appearance. It can be performed with local anesthesia. Good luck and good healing. Dr. Kevin Sadati
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Alar (Nostril Rim) Retraction
The retraction of the alar rim can be corrected with a cartlige graft placed under the skin at the edge of the nostril. Although it does not appear you have any contraction of skin inside the nose, a composite graft of both skin and cartilage is sometimes necessary. Slight lifting of the columella may be helpful - this would be determined at the time of physical examination.
Can my Nostrils Be Lowered or Changed?
The reason for the nostril elevation are given by others. I suspect you had a closed or endonasal rhinoplasty. With open rhinoplasty, this problem rarely happens as the lower cartilages are secured with sutures at the dome and therefore, they won't be able to rotate upwards. The treatment is to reverse what was done which means adding cartilage to the sides of the nose while lowering the retracted nostril skin. This has worked very well on many patients. The columella may also needs to be reduced. The combination of these two techniques will correct the problem.
Alar retraction or excessive columellar show after rhinoplasty
You may benefit not from nostril alteration, but from alteration of the columella and tip.
Nostril alteration surgery alone is a great surgery, but in your case might result in an overly peaked appearance of the nostril.
I am a little skeptical that your tip wasn't touched, because it has that appearance, and tip changes can alter nostril visibility.
However, if you are sure, the nostrils will also become more noticeable for two other reasons:
First, when the bridge is lowered, the nose shortens, displaying more nostril. The amount of shortening is something that the surgeon can control, to produce the changes that you have requested.
Secondly, I see that your middle third has narrowed. This is the site of your internal nasal valves, and what spreader grafts can treat. If your airway has diminished, even slowly enough that you may not be aware of it, you will begin to unconsciously flare your nostrils to keep your airway open. I see that in your pictures.
All of this is correctable. See an experienced surgeon whom you like and trust and who can show you corrections of problems like yours. Good luck.
Nostrils and Columella
The bottom columella portion may need to be lifted a little. Nostrils can be lowered through the alar rim.
Nostril retraction following rhinoplasty can be repaired
Dear Mari: Nostril retraction following rhinoplasty can be repaired. My colleagues have shared many tips for dealing with ala-columella disproportion and there has been discussion involving pushing the nostril margin down as well as pulling the columella back. Based on your photos which are pretty good (thank you), it appears that the issue, as you suggested is that your nostril has retracted. I would recommend either an alar rim graft or a composite graft inside the nostril depending on the cause of the retraction.
Stephen Weber MD, FACS
Repairing alar retraction
Alar retraction can be repaired. Alar rim grafts involve placing a strip of cartilage within the alar rim margin to bring it down slightly. More severe retraction may requiring repositioning of the lower lateral cartilages.
A composite graft to add tissue to the inside of your nostril is sometimes used as well, although I tend to avoid this in my practice as it may result in everting your nostril.
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.