Rhinoplasty is capable of changing many features of the nose based on bone and cartilage manipulations. And while the shape of the nostrils is influenced by cartilage changes at the nasal tip, not all aspects of the appearance of the nostrils can be so changed.
While the width of the nostrils is not necessarily influenced by many traditional manipulations of the structures of the nose, it is often done as part of some rhinoplasty procedures. But because nostril narrowing is a soft tissue procedure away from the support of the nose, it can also be done as a stand alone procedure as well.
Nostril narrowing in rhinoplasty is usually done as the last step in the procedure when the width of the nostrils can be better appreciated against the new nose shape. In some cases the benefit of nostril narrowing is determined during surgery. Often, however, it is apparent before surgery that nasal base narrowing is needed due to the amount of excessive alar flare that exists.
There are different types of nostril narrowing techniques which fundamentally either narrow their width only or is combined with width and length reduction as well. The most common technique is width eduction by a wedge reduction at the lateral aspect of the nasal sill. Usual wedge reductions are in the range of around 4mms which is not insignificant when the procedure is done on both sides. Wedge reduction preserves alar length and, as a result, almost always prevents over narrowing….which is not correctable.
More significant nostril narrowing requires an extended resection along the alar-facial groove which more aggressively pulls in the nostrils with the added dimension of alar length reduction as well. This is often needed in certain ethnic noses that are prone to poor tip support and more widely flared nostrils.
Dr. Barry Eppley
Indianapolis Indiana