Should I get a nostril reduction during or post rhinoplasty operation?

Hello and thank you for your question. Based on your
photograph, you may benefit from a tip refining rhinoplasty. Your surgeon can
accomplish this by trimming, suturing, and reshaping the cartilage in your
lower nose. I would not do an alar base reduction unless you are 100% certain that is what you want.  Make sure you specifically look at before and after
pictures of real patients who have had this surgery performed by your surgeon
and not just a computer animation system. The most important
aspect is to find a surgeon you are comfortable with. I recommend that you seek
consultation with a qualified board-certified plastic surgeon who can evaluate
you in person.
Best wishes and good luck.
Richard G. Reish, M.D.
Harvard-trained plastic surgeon

Hello.  There is no right answer to your question as every nose is unique & there are multiple ways to perform rhinoplasty.  Based on your photo, your tip is bulbous and the alar bases are a bit wider than idea.  Also, keep in mind that one intervention can result in other changes to your nose.  For example, sometimes deprojecting a nose can result in a wider than desired nasal width.  Based on the photos you submitted, I think narrowing the alar bases is probably needed to achieve your request, as well as refining your bulbous tip.  Personally, I would do this at the same time since my goal is to achieve the desired shape in one surgery.  However, your surgeon's recommendation to delay alar base reduction is not unreasonable, but I also think it's best you two have a frank discussion on what is a fair determination of cost.  The decision to have a rhinoplasty is a major decision, so don't feel you have to make a decision right away.  It's actually common to have multiple visits to your surgeon to make sure all your questions are answered.  Take care.

Since the reduction of the alar width would involve a scar along the alar base, most rhinoplasty surgeons try to avoid it unless necessary and desired.  However, your alar bases do extend a bit beyond your medial canthus which makes a case for doing it.

You should avoid having this done unless absolutely necessary to meet your expectations. Your nose will probably look great after the surgery with no need for the alar reduction.

Your ala do not appear to be excessively wide, and based upon your photos I would defer a reduction. Be sure to consult with a board certified plastic surgeon who specializes in rhinoplasty.

Austinnose21,
Thanks for your question and pictures.  Your nasal base (where your nostrils meet your face) does not look very wide based on the photos you have posted, and this may be a reason your surgeon is not doing this upfront at the time of surgery.  Narrowing the nasal base involves cutting skin and subcutaneous tissue out, and is not an easily reversible maneuver, which may be the reason your surgeon is waiting to see how you like the results of the rhinoplasty before doing this.  I would not let the cost of having this done afterwards push you into doing it upfront, as you may be making a bad (irreversible) decision for what will amount to a small amount of money in the long run (based on what it would to cost to deal with this if you don't like it or if it gives you breathing issues).  Good luck!

Hello Austinnose21 and thank you for your question. If needed, I typically perform alar base reductions at the time of surgery. There are a number of surgeons who stage their alar base reductions (do them at a later time). I do not think there is a right answer for this and would defer to the surgeon that you trust. Based on the pictures provided, it is difficult to tell whether this will be needed or not.

Thanks for your posted question. Patients who would clearly benefit from a narrower alar base typically prefer this to be done at the time of the primary surgery. Some cases however are not clear cut and uncommonly, the alar base reduction could be done separately. It is unlikely that profit is the motive, but simply the desire to be considerate and conservative with respect to recommendations since alar base reduction involves incisions on the nostrils and is difficult to reverse. Nevertheless, in your case, I would need more information including an examination and a base view photos to offer a suggestion. Are you considering a complete rhinoplasty or a tip rhinoplasty? Are you planning to do this open or closed? Bulbous tip modifications can change the nostril size and shape, depending on the surgical plan. I may be best to have a few more consultations with other specialists to compare and contract different approaches and results. Take your time a discuss this issue in more detail before you proceed. Best Wishes. 

A picture of the base of your nose would be helpful but I usually do a reduction of the nostril width at the time of the rhinoplasty surgery to avoid another procedure.