Revision Rhinoplasty for Nostril Narrowing Reversal

Q: Dr. Eppley, I’m currently researching for a possible revision rhinoplasty. To provide some background, I had a prior rhinoplasty procedure that included an alar base reduction to narrow the nostrils. Unfortunately there is asymmetry, and I believe it is a bit too narrow. I am aware that these types of procedures are difficult to revise, but I wanted to know if there are any possible solutions. 

For one, I have have researched PDO threads used in temporary nonsurgical face-lifting. Is it possible to use PDO threads to slightly widen the alars by pulling the skin outwards? Similarly, is it possible to do a surgical procedure using permanent sutures to widen the nostril base? If it is feasible, I would definitely be interested in consulting on possible solutions.

Thank you 

A: Nostril narrowing achieves its effect by removing tissue to do so. As a result to reverse their effects is not going to happen by any form of tissue suspension to suturing. Such excisions-based procedures can only be changes by adding tissue back in. And while this can be done, the placement of such a graft will create a mismatch in skin color which is why it is rarely ever done.

That being said an intraoral vestibular subperiosteal release (like is used in the surgical access for a LeFort osteotomy) is well known to widen the nostrils and is one of that procedures acknowledged adverse aesthetic effects. Numerous closer techniques have been advocated in that type of midfacial surgery to prevent nostril widening.

Dr. Barry Eppley

Indianapolis, Indiana