Can My Dynamic Nostril Flaring Be Fixed?

Q: Dr. Eppley, Hello. I am very happy with my nose when completely static. However, it spreads laterally when speaking or with even the slightest smile. It is very dynamic, more so on the right side. I had upper and lower jaw advancement 25 years ago, at a time before an alar base cinch was considered as a last step in the surgery. I have had in-person consultations with 2 surgeons. Both have said there is really nothing I can do except try neuromodulators. When asked about the technique presented in Dr. Eppley’s writing Intraoral Fixation for Nasal Flaring During Smiling, both seemed unfamiliar and said that is not something that would be good to do. As a last effort, I would trust Dr. Eppley’s honest opinion before I give up on the hopes of having this problem resolved. It has preoccupied my mind for decades and causes social anxiety especially around being photographed. I would love to be free to smile and laugh with my family and friends without self-consciousness overshadowing the moment. Thank you for any guidance you can provide.

A:Dynamic lateral nostril flaring is a difficult problem to correct. No matter of the technique used, nostril cinch suturing or actual fixation to the bone (the former is preferred), it has the potential to create some tightness when smiling. So one has to be careful about trading off one problem for another. Thus I would reserve the use of nasal cinch suturing only in the most motivated patient who understands the trade-off and the possibility that if it occurs the suture may need to be released.

Dr. Barry Eppley

Plastic Surgeon