Rhinoplasty After Maxillary Advancement? (photo)

Question

My maxilla was moved forward 6mm to open my airway for apnea purposes. Unfortunately, this movement broadened my nose tip and nostril base quite a bit. I have not had any work done on the nose directly. My surgeon suggested the services of an ENT to fix the look of it, but I am skeptical. Would it be posible to narrow the boney base where the nostril inserts at the cheek, or is this done only for the mid-vault? What should I ask in a consultation to get the best array of options?

Steven J. Pearlman, MD, FACS · Answer

The nose sits on the upper jaw, or maxilla. So any surgery that moves the upper jaw can have a dramatic affect on the shape of your nose. It can also cause a deviated septum since the septum sits in a groove called the maxillary crest of the upper jaw. The nose can be narrowed from top to bottom or selectively. You should seek a qualified rhinoplasty specialist to discuss your goals and desires.

Jose Barrera, MD · Answer

Widening of the alar base is common after maxillomandibular advancement due to the upper jaw advancement and possible buckling of the septum. A rhinoplasty to address the width and buckled septum is appropriate.

William Portuese, MD · Answer

It is fine to undergo rhinoplasty after maxillary advancement surgery, but it is best to wait at least 6 months after the procedure. The goal of rhinoplasty is to narrow the entire nose which is accomplished with both medial and lateral osteotomies. This will narrow both nasal bones and the accompanying upper lateral cartilages. The tip can also be narrowed through different techniques, such as suturing the tip cartilages and conservative cartilage removal. Narrowing the nostrils is best done with an alarplasty procedure whereby a small incision is made at the base of the nostrils, then approximately 3-4 mm of skin is removed, and the nostrils are narrowed.

Stephen Weber MD, FACS · Answer

Your concerns are not uncommon after jaw advancement but hopefully you've benefited from the jaw advancement. Yes, you can benefit from rhinoplasty to narrow the lower portion of your nose. The base of your nose where is attaches to your cheek, can also be narrowed at the same time. I hope this information is helpful.Stephen Weber MD, FACS

Richard W. Fleming, MD (retired) · Answer

The nasal changes you have noticed are common after maxillary advancement, which will not interfere with rhinoplasty surgery at this time. The base of your nose and the tip can be narrowed so the nose is proportional to the surrounding facial features.

Donald Nunn, MD (retired) · Answer

Widening of the nasal base is common with maxillary advancement. I generally place a permanent "cinch" suture through the maxillary surgical site to help decrease this. You could still have this done through the oral incision or may need alar base reduction as part of a formal rhinoplasty. Donald R. Nunn MD, DDS Atlanta Plastic Surgeon.

Gregory Park, MD - Account Suspended · Answer

There are various surgical maneuvers that will change the shape and dimensions of the nose.

To narrow the base of the nose, the pyriform aperture, or the bony opening of your nose is not narrowed. The base is narrowed by a procedure called Weir excisions. This will result in scars along the insertion points of your nostrils and cheeks. Sometimes incisions just inside the nasal sill can be made to narrow the base, as well. A closer, more detailed examination of your nose will help to determine if this is possible.

An evaluation by an experienced rhinoplasty surgeon will be the best way to achieve your goals.
	Thank you for your question and photos. Best of Luck!
	
	Gregory C. Park, M.D.

Rhinoplasty After Maxillary Advancement? (photo)

Answers (7)

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