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Large nostrils or a wide nasal base can compromise an otherwise attractive nose. Fortunately, even conservative removal of the excess nasal base can dramatically reduce the width of the lower nose. About one in ten rhinoplasties require narrowing of the nostrils, most commonly among ethnic rhinoplasty patients.
Dr. Bennett individualizes every patient’s care. A minimum of half an hour is needed to fully understand your expectations and to get a complete history and evaluation of the inside and outside of your nose. Knowing what to expect will make the entire experience more pleasant and increase your satisfaction with the surgical results. Dr. Bennett will discuss the cosmetic and functional expectations of your nostril reduction surgery in detail to make sure all of your questions are answered. Depending on whether you have functional/breathing issues insurance may cover part of your surgery.
Dr. Garrett Bennett can conservatively remove a small wedge of tissue at the nostril bases to narrow the lower nose while maintaining a natural appearance. He is usually able to perform rhinoplasties from the inside part of the nostril, not from where the nostril attaches to the cheek. Making a nostril reduction incision on the outside of the nose increases the likelihood of visible scarring. Dr. Bennett prefers to hide the scar on the inside part of the nostril using a procedure called a Weir excision. This technique can narrow your nostril bases, reduce the length of your nostril sidewalls, and make your nostrils smaller, depending on the design of the wedge excisions.
The proper post-operative nostril size is different for every patient, as the goal is to blend the new nose harmoniously with the entire face. You can find an approximate symmetrical nostril width by drawing two imaginary vertical lines from the inside border of each eye down to the lateral sides of your nose. The distance between the lines is equal to the width of your nose, with the lines marking where the outside borders of the nostrils should be. Reducing a large tip or bringing the tip of the nose closer to the face often causes the nostrils to flare toward the cheeks, but Weir excisions can reduce this flaring. They can also be used to make oversized nostrils smaller.
The scar from a Weir excision remains hidden inside the nostrils and can be virtually invisible. Regardless, the benefit of the excision outweighs any negatives of a small scar. The diagram above shows the incision lines typically used for Weir excisions. The incision may also be entirely inside the nostrils.
Dr. Bennett uses a special suture, placed inside the nose, that narrows the nasal base and is hidden under the skin, between the nostril edges. Dr. Bennett may use this suture alone or in combination with a Weir Excision.
Asymmetries in nostril size, shape, or thickness can also be corrected with nostril reduction techniques like cartilage grafts or fat transferal. Cartilage grafts can create the natural curvature of an attractive nostril. A revision rhinoplasty can correct either collapsed or twisted nostrils from previous rhinoplasty surgery. Revision rhinoplasty can sometimes improve the appearance of poorly hidden scars from a previous nostril, depending on where the scars were placed. However, the best results from nostril narrowing are generally obtained in the first rhinoplasty.
The week after the procedure it is normal to have a mild headache for a day or two. You will be given some pain medicine, although most patients take only one or two doses and then switch to an over the counter pain medication. If you see scant, reddish fluid draining from the nose, you should place a dressing under the nostrils to avoid sniffling. You will probably feel a lot of congestion, although some people can breathe very well immediately after surgery. You may have bruising and swelling around the nose and eyes. This will start to resolve within a few days. Most swelling will go down after a couple of weeks, but changes in the nose can continue for a year or more. You will return to the office one week after surgery to have the nasal dressing removed, then return as needed to have the nose checked. Avoid strenuous exercise for three weeks. Avoid wearing glasses for six weeks
Dr. Bennett is a double board-certified ENT and facial plastic surgeon. He authored the leading paper “Long-term effects of alar base reduction”, published in The Archives of Facial Plastic Surgery and used as the primary educational article for nostril reduction in the Otolaryngology Home Study Guide and cited by many other articles on nostril narrowing.