Very possible to reattatch MC Footplates to caudal septum
The short answer to your question is that it is very possible to re-attach the medial crural footplates to the caudal septum. This is a relatively common maneuver in rhinoplasty in order to change the projection of the nose, change the amount of columellar show, and also to narrow the flare you are seeing in your nostrils when you are not smiling. The problem is that there may be many other reasons for this area widening when you smile.
Some of these reasons may have to do with changes to the nose that took place during primary rhinoplasty and other reasons may have to do with the shape of your nose as it relates to the rest of your face and the degree of nasal tip support.
I would suggest having a consultation with a qualified rhinoplasty surgeon and specifically ask about this issue.
Reattaching MC footplates to septum possible, but not that simple
Without actually looking at your photos, smiling and neutral it is hard to say why your nostrils flare with smiling. It could be lack of tip support or rotation from your first surgery. It may be related to how the medial crural foot plates are attached to the septum. Usually there is some membranous component to the attachment and only when doing radical changes such as placing a septal extension graft or rotating and or shortening the nose can one overlap and attach the medial crural footplates to the septum.
It is relatively easy to do this but I can't say that doing it will solve your problem without actually seeing you or photos of you. I hope this helps.
Attachment of MC Nasal Footplates is possible
Reattachment of the of the footplates of the medial crura of the lower lateral cartilages is possible. However, you should first determine if your nasal surgeon agrees with your diagnosis. Although abnormal position of the footplates may create an undesireable appearance, it is unlikelly this would cause increased width with smiling.
To answer your question, yes it is possible. The surgeon would just have to open the collumela and expose the footplate of the MC and use a permanent stitch to reattach it to the caudal septum.
Reattaching medical crural footplates after rhinoplasty
Reattaching medical crural footplates after rhinoplasty or medial footpods is a straight forward procedure. Basically, an incision is made in the membranous septum just behind the footplates and the footplates are freed up and reattached to the septum in a tongue and groove fashion. I have done this procedure many times and it is effective in stablizing the tip complex and keeping it from splaying and also can be used to affect minor projection of the tip or deprojection of the tip depending on how the footplates are sewed to the septum. That was an excellent question. It can also help minor flare issues by elongating the columella once again depending upon how they are advanced and sutured. I hope this information helps.
Reattaching the medial crira can be done, but the alar flare will not get affected.
The only surgery that does away with ala flare when smiling is a Weir resection, it cuts the small muscles that cause the flare. Weir resection puts a scar around the base of the ala.
Treating the foot plates of the medial crura do not impact the flare that you see when a patient smiles. This is normal. Many times flare of the foot plates can be treated by partial excision or suturing them closer together.
It is very common for nostrils to flare when you smile
To answer your question, it is possible to re-attach the medial crural footplates to the septum. However, anatomically this is unlikely to alter the width of your nose on smiling. There are a number of reasons why the nose widens on smiling, Two muscles pull the tip down and subsequently can flare the nostrils. These are the nasalis and depressor septi muscles. The nostrils insert into the cheeks and based on your smile, the cheeks may always pull on the nostrils.Lastly, if the tip of your nose stuck out very far and what is called projection was reduced, the nostrils can flare which can then exaggerate changes with smiling.
I suggest you seek a qualified revision rhinoplasty specialist to discuss your nose and figure out the best way to address it, which may as simple as an alarplasty.
Ala (nostril) widen when smiling.
The attachments of the medical crural footplates can be sutured to the ventral caudal septum through a hemi-transfixion or columellar incision along the nasal vestibule. However, the width of the nares which is aggravated by animation (particularly smiling) is not likely to be effected and is probably more directly related to the combined activity of the dilator nare\is anterior, levator labii alaequae nasi, alar nasalis muscles. You may want to consider a modified Weir alar base reduction and/or cinching suture and/or botulinum toxin treatment (such as dysport).
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