We analyze such problems under “nasal floor problems”.

It is difficult to come up to the aesthetic proportions of the nasal base without correcting these problems.

Wide nasal wings usually coexist with large nostrils (>90%), but there are cases where both conditions are seen in isolation. Sometimes, although the nostrils are large, nasal wings can be narrow and thin. Sometimes the wings can be very fleshy and wide, although the nostrils are of normal size.

Nasal floor problems are limiting factors in rhinoplasty.

This is because nasal floor problems are closely related with other proportions and aesthetic subunits of the nose.

The basics first:

1. The size of the nostrils and the width of the wings are related to the height of the nasal tip.

When you look carefully at the noses of African and Asian races, you will see that most individuals have wide nasal wings and large nostrils. When you look more carefully, you will see that the height of nasal tips is also insufficient. Aesthetically, structurally and functionally, the “ideal” nasal tip height (projection) should not be less than 30mm. As the height of the nasal tip decreases, the wings become wider and wider, and the nostrils are perceived to be larger than normal. You can test this effect by pressing down on the tip of your nose with your finger.

2. The width of the nasal wings is proportional to the width of the nasal root and of the nasal ridge in the anterior view.

When you look at the nose from the front, if you have a very narrow nasal ridge, this causes the nasal wings to appear relatively wider. In cases where the distance between the aesthetic lines of the nasal ridge is narrower than 4mm, even a structurally narrow nasal base can be perceived as relatively wide. We call this a radix-base mismatch.

3. Wings appear wider as the nasal tip narrows

When a nose is viewed from the front, there is an aesthetic ratio between the width of the nasal tip and the width of the nasal base. The more separated the nasal cartilages are from each other, the more these cartilages support the nasal wings. If the nasal cartilages are brought very close to each other and are reduced too much, a very narrow nasal tip may emerge. As the nasal tip narrows, the wings and nostrils appear relatively wider.

4. Of the two nostrils of the same size, the more rounded and horizontal one is perceived to be larger than the more vertical and elliptical one.

Sometimes you think you have big nostrils, but the problem is not that they are large, but that their shape is different from what is ideal. The more rounded and horizontal the nostrils are, the “bigger” they are perceived. If you make the nostrils elliptical in the anterior-posterior axis without ever reducing their size, the illusion of being big disappears. The most effective way to change the shape of the nostrils without reducing them is to increase the height of the nasal tip, as I mentioned as part of the first option. Another effective option is to change the shape of the nasal cartilages to a more ideal configuration.

 

 

5. As the nasal tip is lifted further, nostrils will be more visible.

Nostrils being large and being "visible" are two different things. As the nasal tip is lifted further, the nostrils will become more visible and draw attention. Even nostrils of normal size may be viewed as very unnatural and conspicuous in upturned noses. Sometimes, patients with nostrils actually quite large are not disturbed by this at all because their nasal tips are low. Even though they are large, the nostrils are not visible when viewed from the front. As a rule, the nose should not be shortened and lifted too much in patients with large nostrils and wide wings. In noses that are given a lift, both the nostrils will be very prominent and the slight asymmetries between the nostrils and the wings will suddenly become remarkable.

6. If the nasal wings are large due to the thickness of the nasal skin and soft tissues, it may not be possible to perform an effective reduction.

For instance, there is a disease called “rhinophyma” in which the nasal skin becomes excessively thick. The nasal wings and base are also excessively enlarged in this disease. In some rhinoplasty patients, soft tissue may thicken due to medications, overgrowth of subcutaneous sebaceous glands, and allergies. Sometimes the nasal skin is structurally very thick, and the wings are structurally very “fleshy”. In such cases, it is not possible to attain a satisfactory surgical result. Then, it should be clearly understood by the physician and the patient that the nasal base cannot be sufficiently narrowed down initially. Unrealistic expectations result in disappointment. If it is not possible to narrow the base, there is no other option but to build the nose proportions (i.e. enlarge and shape the nose) according to the existing base width.

7. We can only reduce the nasal wings and nostrils by "a few millimeters".

We can only reduce the nasal wings and nostrils along the alar fold on the lower outer part of the nasal base. The part that can be reduced corresponds to 15-20% of the total circumference of the nostril. A maximum of 3-4 mm of tissue can be removed from this section. More of it disrupts the fine anatomy of this section, resulting in an unnatural appearance revealing previous surgery. In other words, you cannot shape the nose first and then reduce the wings and nostrils accordingly. Wing/nostril reduction has its own limits. It is necessary to foresee this limit and shape the nose accordingly.

8. Reduction of the nostrils and wings is irreversible.

However, wings or nostrils can be reduced in a second session of 20 minutes under local anesthesia, always following the surgery. It would be wise not to burn bridges in the in-between situations before or during the operation where you cannot decide precisely. You can always reduce them later if needed. However, if you reduce them unnecessarily, that sets a point of no return.

In the light of this basic information, we have some essential principles that we apply.

In cases where it is necessary to narrow down or reduce the nostrils,

• We apply surgical techniques that narrow the nasal wings and reduce the nostrils in an extremely cautious, conservative and minimalist manner.
• We try to maintain or even increase the height of the nasal tip as much as possible.
• We avoid narrowing down the nasal tip and ridge too much and even expand it when necessary.
• We try not to raise the nasal tip too much.
• We do not always reduce the nostrils and wings, but in some cases we may choose to reshape them.
• The nasal skin and soft tissue are sometimes very thick. In such cases, this can set an obstacle to obtaining an elegant nasal base. Unfortunately, some problems have no solutions.

If you think that your nasal wings are wide or your nostrils are large and want to get detailed information about how these problems can be resolved for you during rhinoplasty, feel free to contact us.

Take good care...

... of yourself and your beauty.

OB