Apr 17

Nostrils that are too wide

The complaint of a nostril that is “too wide” is a problem which we more frequently encounter among certain ethnic groups: African Americans, Asians, and some Hispanics. Alar base (“nostril narrowing”) surgery poses a unique set of difficulties, which should not be understated.

All too often many surgeons make it sound like, “No problem, we’ll just take a little wedge of tissue out from both nostrils.”

Unfortunately, external incisions can be noticeable, even when designed correctly. Most commonly, evidence of alar resection is noted as a teardrop or “Q” deformity in the base of the nostril. In others, the nasal base appears abnormal, as the smooth contour of the nostril has been interrupted (see Michael Jackson) or because resection has resulted in more marked asymmetry. Moreover, overresection can result in a narrow dysfunctional nostril opening that is difficult, if not impossible, to correct.

Michael Jackson Pre Rhinoplasty Michael before surgery had relatively wide nostrils.

Michael Jackon transition When Michael first had rhinoplasty you see transition after alar base reduction to a smaller nostril size, but it still looked relatively normal.

Final Michael Jackson Michael Jackson after numerous revision rhinoplasties has ended up having very irregular nostrils, which are dead give away for having been “done”

In general, we employ alar base modifications in the context of an overall surgical plan and normally defer this portion of the case to the end of the surgery. No surgeon can determine preoperatively the exact location, shape, and amount of alar base alteration which is required because nostril size and shape as well as alar base width and flare (see our online textbook for more information regarding these definitions) are all affected by other modifications made during rhinoplasty. Specifically, increased tip projection (making the tip bigger), will often sharply reduce the alar flare and alar base width. On the other hand, retrodisplacement of the nasal tip (making the tip smaller) has, at least classically, been noted to create alar flaring as well as a rounded nostril.

So if you have wide nostrils, we recommend you view alar base surgery as a useful adjunctive measure that can be used to provide an additional measure of refinement. With this in mind, and in the right hands, alard base reduction can maximize the chances for a smooth, natural nostril contour with no discernible scar. When its overdone, or done incorrectly the results can be difficult to fix.

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