Excessive Narrowing of the Nose After Rhinoplasty
Rhinoplasty should not lead to a narrow nose. Excessive narrowing of the nose could indicate a deficiency in the middle nasal vault. That can be corrected using cartilaginous grafts from the nasal septum, ear cartilage, or rib.
The nose can be widened to a great degree, but the more important question is if it is affecting breathing or not. In case of breathing issues, spreader grafts will help improve the breathing and dorsal grafts will improve the narrow appearance. Spreader grafts are thin, long cartilage grafts placed between the nasal septum and upper lateral cartilages to help expand the nasal valve angle.
The best practice is to avoid excessive narrowing of the nose at the time of surgery. This can be accomplished with a conservative technique, the use of precise incisions, and fine instrumentation. The dictum ‘less is more’ applies to rhinoplasty more than any other surgery.
Any aggressive maneuver that reduces the nasal dorsal hump and violates the relationship between the upper lateral cartilages and the cartilaginous nasal septum can lead to narrowing of the middle third of the nose.
This can be avoided by incremental reduction of the dorsal septum. If the problem is identified during surgery, then any of the harvested cartilage can be put back in place and sometimes held in place with through and through skin sutures to ensure proper thickness of the mid nose. In some mild cases, post-operatively hyaluronic acid can be used to plump up that area. In case the deformity shows in the late postoperative period, it can be corrected in the office under local anesthesia by placing a small cartilaginous graft obtained from the ear.
Dr. Tanveer Janjua is a recognized leader in facial plastic surgery. He currently practices at Janjua Facial Surgery in Bedminster, New Jersey. More about Dr. Janjua…
For more information on nostril reduction surgery or to schedule an appointment, contact us toll-free at 877-JANJUA1.
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