Your Questions
Your Questions
Q: Dr. Eppley, I had a nostril narrowing procedure done a few years ago and the scar was hidden underneath the nostril, but now I have these two slits in the nostrils where the skin should be filled out. Is there a way to plump up the skin with filler or cartilage in the nasal still?Will these incision leave a scar? From looking at my pictures, do you think the cartilage grafting will make my nasal sills look natural? Do the cartilages last a long time and is it possible for the cartilage to come out of place from the “slits?” Where would the incision site be? I hope I can fix my nasal sills, they are so obvious and it makes my nostrils look awkward.
A: To do the surgery, of course, incisions will need to be made. But they will be made within the scars you already have. The way to make your nasal sills look more natural is to remove the slits in them which are not normally present. One would think that just cutting out the slits and put the skin edges together should work (and that alone might) but there is definitely a propensity for scar contracture to ultimately re-create a notch or slit. That is the purpose of a small sliver of cartilage graft. By placing a small sliver of cartilage underneath the skin edges prior to closure, it serves as a bridge of support for the overlying skin to prevent a recurrent slit sill deformity. Cartilage normally does not resorb so its support will likely be permanent. Even if it does ultimately resorb it will do so over time…long after the nasal sills have healed
Dr. Barry Eppley
Indianapolis, Indiana
Q: Dr. Eppley, during my maxillary jaw surgery my upper jaw was advanced too much by 3mm and impacted by 2 to 3mms. As a result, it makes my nose look wider…is there anyway to make the nostrils look slightly narrower?
A: The nostril flaring to which you refer is very typical for a maxillary osteotomy and has nothing to do with that the fact that the maxilla was impacted or vertically shortened. Every maxillary osteotomy detaches the facial musculature, and unless that is put back at the end of the operation by a V-Y mucosal closure and alar cinch sutures, nostril flaring (increased bi-alar width) is going to result. That can be narrowed by a very simple alar narrowing procedure through a sill excision technique.
Dr. Barry Eppley
Indianapolis, Indiana
Q: Dr. Eppley, I had an alar cinch suture to reduce nostril flare and widening. What is the recovery like from a alar cinch suture. I had one a week ago and see no change. Nostrils actually look wider, should I expect it to look worse before it looks better? The surgeon overcorrected but it doesn’t look that way. Face is very stiff and upper lip doesn’t move, laughing is very painful. The stitch will absorb in 3-4 months. Can this all just be swelling? Does it need to be a permanant suture to have lasting effect?
A: You did not say exactly why you had an alar cinch suture. Was it as part of a maxillary osteotomy or rhinoplasty procedure? And what was its purpose?
The reason that I ask these questions is because an alar cinch suture is really a preventative nasal base maneuver rather than a treatment for nostril narrowing in most cases. If the purpose was to actually narrow the nasal base/nostril width, I would not expect it to be particularly effective. By pinching the alar bases together by suturing, a whole host of symptoms result from so doing as you have described. Stiffness and negative effects on upper lip movement will result. While the swelling and these symptoms will resolve with time as the suture relaxes/absorbs, I would not expect any nostril narrowing (even if it was created) to be sustained. Certainly a permanent suture is not going to be the answer.
If the goal was to narrow the nostril base for wide or flaring nostrils, there are much more effective and less arduous procedures to do. Alar base resection is more effective, easier to go through and permanent. Careful placement of the incisions in or around the nostrils can result in a low risk of any adverse scarring.
Dr. Barry Eppley
Indianapolis, Indiana
Q: Dear Dr. Eppley, I want a rhinoplasty and as part of it I’d like a wedge excision procedure to reduce the alar flare without reducing nostril size. However, there seems to be a lot of concerns with the wedge procedure as it leads to some external scarring. I wouldn’t mind this if the scar itself was camouflaged within the alar crease. My main concern is that there might be an obliteration of the facial alar groove with this procedure. Is this a real concern? What is the best way to go about this without obstructing the alar crease?
A: There are two basic skin excisional approaches in rhinoplasty to change the bottom shape of the nostrils. The first technique is the removal of a vertical wedge of skin inside the nostril just next to the lateral nostril wall. This will reduced the flare of the ala with minimal narrowing of the nostril width. This leaves no visible external scar and will not alter the alar-facial groove. This appears to be what you may need. The other technique is where this inside the nostril excision is extended out along the ala-facial groove. This results in significant nostril narrowing as well as flare reduction. This does place a scar in the alar-facial groove which, if well placed, is not a visible scar concern. It does not result in any chance of effacement of the alar-facial groove.
Dr. Barry Eppley
Indianapolis, Indiana