Can a surgeon make my nose thinner during nasal valve repair so that my nose doesn't get any wider from the grafts?

This is a great insight. If you have a wide nose it is certainly concerning that adding additional tissue as supportive grafts could make the nose wider. I regularly worry about this and we have found that by placing the grafts into the precise spots needed for support, along with thinning areas of thick skin and other tissues where necessary, we can provide the support needed without materially widening the nose, and in fact, helping the nose to look thinner while still functioning better.

Hello and thank you for your question -- a very good question at that ☝️

The short answer is that carefully placed spreader grafts (to stent open your internal nasal valves) when combined with careful osteotomies to narrow the nasal bones will not widen your nose.

The long answer is as follows..,

Many factors can create difficulty with your nasal breathing: (1) internal nasal valve collapse, (2) external nasal valve collapse, (3) a deviated septum, (4) internal bone obstruction, and others... Each of these etiologies can be individually addressed in surgery and be combined with other surgical maneuvers to prevent widening of your nose. Those 4 factors are discussed below...

(1) Internal nasal valve collapse is essentially when the side cartilages are collapsed onto your septum. Cartilage is cut into small segments called "grafts", and are used to "spread" this valve open, hence the name "spreader grafts" -- this is what your doctor was likely referring to when repairing your nasal valve.

(2) External nasal valve collapse (aka nostril collapse) can be treated by again stenting your nostrils with carefully placed grafts to stabilize each nostril (also called ala) and are called alar contour grafts or alar strut grafts. I place extended alar contour grafts to stent your nostrils open and add stability to your nostrils routinely in all my rhinoplasties (and septoplasties).

(3) A deviated septum can be corrected by straightening the septum or cutting out the portion of your septum that's deviated -- this is called a septoplasty.

(4) Inner bony obstructions that disrupt airflow in your nose can be debrided, excised, or shaved down to improve your breathing.

Again, all of the above can be done without widening your nose when combined with other careful surgical maneuvers. Moreover, health insurance can cover all this at minimal cost to you☝️

If you have any cosmetic concerns, a rhinoplasty can also be performed to improve your nasal appearance.

The next step for you is to pursue the right plastic surgeon for your septoplasty, with or without a rhinoplasty. In your consultation, be sure your surgeon addresses all your functional (and aesthetic) goals and concerns specifically, IN PERSON, and discusses the surgery details including the position and size of the incisions used (with actual photographs and not just digital animations), the risks and benefits of the procedure, recovery time, and post-operative course. I also think a key component of your consultation is to establish a good connection with your plastic surgeon. This is difficulty to do without seeing your surgeon in the office, in person. It’s the connection that allows you to clearly define your desired nose outcome goals, the first step of this whole process. If you don’t feel you have a good connection with your plastic surgeon after your consultation, he/she may not be the best surgeon for you.

For more information on septoplasty, please refer to my link below.

Good luck.

Mark K Markarian, MD, MSPH, FACS
Harvard-trained Board Certified Aesthetic Plastic Surgeon

The simple answer is yes, you can improve the nasal valve while undergoing cosmetic rhinoplasty to improve your overall shape, including making it thinner. The most important thing is to see couple rhinoplasty experts with a lot of experience in combining these procedures for the best result.