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Nostril Re-shaping

One of the most difficult aspects of rhinoplasty is changing the shape of a nostril. Additionally, because there are two, it is important that they both match. The main deformities that we see are the following:

1. The nostril is too wide or flared, with the long axis in a horizontal rather than a vertical direction.
2. The nostril is too narrow.
3. There is a notch or retraction along the superior border.
4. There is an overhang of tissue along the superior border.

To correct a wide or flared nostril, we can remove tissue at the posterior aspect of the nostril before it attaches to the cheek or, at times, remove tissue from the nasal floor.

In less severe cases, a suture may be placed beneath the nose to cinch the nostrils closer to the midline. "Additionally, freeing the nostrils from their underlying bony attachments allows the nostrils to contract inward."

To correct a narrow nostril, a straight cartilaginous strut can be placed along the margin of the nostril to widen the opening. In more severe cases, a flap of tissue located to the side of the nostril can be rotated in to expand the opening. This latter procedure is especially useful for patients with restricted airways to improve breathing.

When there is a notch or retraction along the superior border of the nostril, there are two methods that can be used to correct this. In mild cases, skin can be rotated downward and outward from within the nose, either with or without a cartilage graft for stability. In more severe cases, a composite graft of skin and cartilage, taken from the ear, can be placed within the nose to lower the rim.

Finally, in cases where there is excessive overhang along the superior border, this tissue can be pulled up internally and trimmed.

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The Telltale Signs of a Bad Rhinoplasty

Having revised thousands of rhinoplasties, I have noticed certain features common to all.

Even a structurally symmetric, aesthetically pleasing nose can be a poor result if it is out of proportion with the other facial features by being too small or too large. However, the real clues to a poor result are the asymmetries, malpositions, disproportions and decreased function that are seen. We can see collapse of the side walls and/or nostrils producing a “pinched look” or asymmetry between the two sides. The bridge can be too low or too high, and the tip can be overly rotated or not rotated enough. There can be too much “nostril show” from aggressive cartilage resection causing upward migration of the nostril rims. Or too much nostril show from failure to raise the columella (area between the nostrils). Also, irregularities or distortions in the nasal tip can occur which can present technical challenges to the revision surgeon. There can be deflections or angulations of the tip or the entire nose. As mentioned above, nostril asymmetries are particularly common with one nostril appearing higher or wider than its companion. Finally, there can be a worsening of breathing , especially if a reductive rhinoplasty was performed. Making a nose smaller has to be accompanied, many times, by measures to assure that the airflow is not compromised. This means correcting any septal deviations and/or turbinate enlargement, as well as maintaining adequate openings through the nostrils and the areas above called the internal valves. I’ve included photos of a nose showing most of these deformities with the subsequent post-operative results, after I corrected them.








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