Feb 8

Can nostrils be lifted?

Category: Uncategorized,

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.

Alar Base Scar RevisionAlar Base V-Y revision

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.

abrlat compositeAlar Base Skin Graft

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.

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2 comments

2 Comments so far

  1. Lutgarde October 25th, 2011 1:40 pm

    Dear doctor
    Last year I wanted a refinement of my nosetip. I thought I had one bigger nostril. (in fact I had a deviated septum) The doctor I went to did an alar base reduction on me by removing a wedge of 5mm on both sides of my nose. (completely unnessary) Then she put my nosetip extremely small by removing almost all the cartilage in my nose. My nose looks terrible now and I can’t breath anymore. The contour of my nose and nostrils is completely unnatural. I know my nostrils will need to be lifted again but I am very afraid because I already heard it was unfeasible. Now I read your article and I have some more hope there can be done something to give my nose a more natural look back. I don’t mind the scars or the problems with colour or skinmatch. Point is, is it possible to do something about it and if so, do you perhaps some pictures who had this done. I didn’t find any information of people who already had this done.
    If you could help me I would be very greatfull.
    Kind regards
    Lutgarde

  2. admin October 25th, 2011 3:30 pm

    Hello Lutgarde,

    So sorry to hear that you are unhappy with your nostril reduction. Hopefully, something can be done to improve the appearance, but each case needs to be evaluated on an individual basis. If you’d like, please send some front and profile photos to our main site http://www.beverlyhillsprofiles.com on the Contact Us page and we can talk in more detail.
    Regards,

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