Wide Nostrils and Nasal Tip
A wide tip can be related to a wide nasal base or due to a broad, bulbous tip. Several techniques are available to slim wide, flared or thick nostrils using alar base reduction rhinoplasty.
Many people are surprised to find out that the outer portion of the nostril region (also called the ala) does not have any cartilage in it. The schematic outlines this anatomy very well:
The outer alar margin and sidewall are made of fibro-fatty soft tissue. People with thicker ala don't have thicker cartilage, they just have more of this fibro-fatty tissue. This can create a more flared or wide appearance to the nasal base.
How to make the nostrils less wide with wedge excisions
A common method to reduce the width of the nostrils is to perform a wedge excision (also called Weir excisions) of alar soft tissue. The schematics below show two possible styles of wedge excisions. The first maintains the inner nostril circumference as seen in the schematic below:
The second technique includes the excision of some internal nostril skin to further reduce the nostril size:
The benefits of the wedge excision technique is that the resulting scar is hidden in the natural crease that exists where the ala meets the cheek. This incision is typically closed with at least two layers of sutures. A deep suture layer involves dissolveable sutures, whereas the outer skin sutures are usually trimmed 1 to 2 weeks after surgery.
How to narrow the nostrils with a nasal sill excision
An additional method of reducing nostril width is to excise skin from the floor of the nostril (also called the nasal sill). This technique is especially useful in patients with a wide nasal floor and it can also be used to treat flared nostrils. Various incision shapes can be designed including a diamond, triangle, or rectangle of tissue.
Great care must be taken in suturing the area closed. It can be harder to hide the resulting scar, though some people do have an already existing crease where the ala meet the nasal sill where an incision can be placed. The schematic below shows how a diamond shaped incision can be used.
Combined wedge excision with and nasal sill excision to narrow the nostrils
In some instances it is best to combine a wedge excision with nasal sill excision to appropriately narrow the nostril area. This typically occurs when significant narrowing is desired.
Management of the alar scar
The skin around the nostrils has abundant oil glands and in some cases it is recommended to inject dilute steroid in the scar after surgery to improve healing. In other cases the scar can be further minimized by performing dermabrasion (sanding) about two to three months after surgery. Dermabrasion can be done in the office with local numbing medicine if you desire.
Before and After Nostril Reduction Rhinoplasty Photos
The photos below show some before and after alar base reduction results: