Can my Nostrils Be Lowered or Changed?

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

The bottom columella portion may need to be lifted a little. Nostrils can be lowered through the alar rim.

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.

 

I read your concern and reviewed your photos. You appear to have a bit of nostril retraction which is causing excessive nostril-show. A well-performed Injectable Filler procedure may be beneficial for lowering the height of your nostrils. In my practice, I prefer Silikon-1000, an off-label filler for permanent results. I hope this is helpful for you.

Regards from NJ.

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.

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

The nostril can raise up and show the columella after rhinoplasty if the cartilage in the tip is over removed or the lining inside the nostril is removed or injured. The ala will notch or draw upward as in your photos and can give a bit of an angry look as you describe. Revision can bring the ala back down and into better balance, sometimes with a graft in the contracted area. It is discouraging that you believe the tip was never touched, yet your results show otherwise.
Best of luck,
peterejohnsonmd

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.

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.

Dear Mari:

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.