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Rhinoplasty surgery is fundamentally about altering the osseocartilaginous framework of the nose. It’s primary soft tissue effect, the redraping of the nasal skin over and around the altered support framework, is largely out of the surgeon’s direct control. But there is one soft tissue element of the nose which can be changed and that is the nostrils with emphasis on nostril or alar base width.

There are numerous methods of nostril narrowing with different locations of the tissues removed based on the exact changes that are desired. The most common method is an internal excision of the sill to reduce transverse alar width. It has the advantage of the most hidden scar and is usually good for up to 4mms width reduction per side.,

But in the wide flared nostrils, often associated with weak tip projection, sill excision is inadequate and will have minimal effect on reducing the flaring. Such flaring can only be reduced by a full thickness wedge excision of the base of the nostril. Such wedge excisions are comprised of skin and fibrofatty tissue. Based on how the wedge excision is marked along the outer nostrils the internal mucosal lining of the nostril may also be removed. 

There are different ways to orient this wedge excision based on the desired effect. Most commonly the wedge excision wraps around the nostril to include both sides of the nostril for maximum flaring reduction. But to prevent making the nostrils too narrow, based on the projection and width of the nasal tip, the wedge excision can stop short of going inside the nostril. This reduces nostril thickness and flaring but keeps the intranostril width reduction more limited to avoid the risk of overly narrowed pinched nostrils. (which is irreversible)

This approach to flared nostrils is useful when the tip is not overly long or narrow. It keeps the side of the nose in proportion to its central shape.

Dr. Barry Eppley

World-Renowned Plastic Surgeon

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