One of the most difficult aspects of rhinoplasty is changing the shape of a nostril. Additionally, because there are two, it is important that they both match. The main deformities that we see are the following:
1. The nostril is too wide or flared, with the long axis in a horizontal rather than a vertical direction.
2. The nostril is too narrow.
3. There is a notch or retraction along the superior border.
4. There is an overhang of tissue along the superior border.
To correct a wide or flared nostril, we can remove tissue at the posterior aspect of the nostril before it attaches to the cheek or, at times, remove tissue from the nasal floor.
In less severe cases, a suture may be placed beneath the nose to cinch the nostrils closer to the midline. “Additionally, freeing the nostrils from their underlying bony attachments allows the nostrils to contract inward.”
To correct a narrow nostril, a straight cartilaginous strut can be placed along the margin of the nostril to widen the opening. In more severe cases, a flap of tissue located to the side of the nostril can be rotated in to expand the opening. This latter procedure is especially useful for patients with restricted airways to improve breathing.
When there is a notch or retraction along the superior border of the nostril, there are two methods that can be used to correct this. In mild cases, skin can be rotated downward and outward from within the nose, either with or without a cartilage graft for stability. In more severe cases, a composite graft of skin and cartilage, taken from the ear, can be placed within the nose to lower the rim.
Finally, in cases where there is excessive overhang along the superior border, this tissue can be pulled up internally and trimmed.