Because our practice focuses heavily on rhinoplasty and revision rhinoplasty, we see many patients every week who are unhappy with their previous rhinoplasty result. One of the greatest sources of unhappiness is a poorly performed nostril reduction. Nostril reduction or narrowing is a relatively common procedure performed along with rhinoplasty and, done well, it often is a really nice finishing touch to a great nose job. See our blog of Dec 08 to get a sense of How we do alar base reduction differently.
Problems usually occur after nostril narrowing because of poor technique and especially overaggressive removal of nostril tissue. This can lead to the typically triangular, pinched, tethered nostril appearance, a dreaded look that should really never happen. We’ve also seen this problem occasionally after lip lifting procedures where tissue is removed from the bottom of the nostrils across the columella to try to pull up and show more of the upper lip. Sometimes, the lip is not lifted so much as the base of the nose is pulled down. We’ve blogged before about how to prevent nostril narrowing problems. But, what can you do if you’re already there?!?
The answers are unfortunately not simple nor perfect but, there is some promise of help in many cases. In our experience, there are a few reliable ways of getting some degree of improvement in this situation depending on the severity. If the problem is merely poor scars, this can be pretty readily treated with resurfacing techniques such as chemical peels, laser, or dermabrasion. If the problem is mild notching or tethering of the nostril, this can sometimes be improved with what is called a V to Y advancement. See the diagram below to get a picture. Essentially, when the scar is revised, some tissue is ‘borrowed’ from the cheek/lip area where it meets the nostril edge in order to elevate the nostril attachment. The downside of this approach is that it leaves a vertical scar along the upper lip although every attempt is made to hide it in the natural crease in this area.
When the situation is more severe, there is no choice but to return some normal tissue to the area where too much nostril tissue has been lost. As shown in the diagram below, the nostril scar must be opened and some skin (usually taken from behind the ear or some other non-visible area) must be placed into the area to try to recreate the normal curvature of the nostril.
This can produce a very nice result but it does create some potential headaches of its own because of visible scars and possible skin color matching issues. Obviously, the absolute best result is achieved by getting it right the first time. If it’s your first rhinoplasty, don’t let posts like this discourage you…just find the right rhinoplasty specialist for your procedure.2 comments
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