Can My Nose Be Made To Have Less Nostril Show?
Q: Dr. Eppley, I have an interest in a revision rhinoplasty. I had a prior rhinoplasty to try and make my nose thinner and smaller. But unfortunately that has not been how it has worked out. As you have previously written on your blogs, the more skeletal framework we take away from a thick nose such as mine, the more shapeless it may become. I have finally come to accept that my nose will never be small, but I am hoping that the tip can be a bit more defined. Also, I noticed that my nose exhibits lots of nostril show since the surgery. Would it be possible to make my nose longer, so that the nostrils will be less noticeable along with further nostril size reduction? Maybe you can see that my nose kind of looks like a pig’s snout similar to the “before” picture of the lady’s picture I have attached. I’ve attached a picture of myself along with a before and after picture I found online.
A: What you are talking about is that you have a bit of an overrotated nasal tip from the prior procedure, resulting in excessive nostril show. This can definitely be improved by a revisional rhinoplasty procedure using a derotation manuever with a tip lengthening graft (to push it down and forward) and nostril rim grafts to lower the outer alar rims. This would require a septal cartilage graft, which although some has been taken from the prior procedure, most likely enough may exist to do these extension tip grafts. This is an unknown variable that can only be determined at the time of surgery. As a secondary option, we would have to be prepared to use ear cartilage if necessary. Septal grafts are preferred because they are straight and more stiff.
Dr. Barry Eppley