Wide Nostrils | Alar Base Reduction NYC

Dr. Sam Rizk is double board certified in facial plastic surgery (see board certification section of this website). Dr. Sam Rizk has had extensive training in both cosmetic and reconstructive rhinoplasty at New York’s best hospitals, including Memorial Sloan Kettering Cancer Center and New York Hospital, as well as Manhattan Eye, Ear and Throat hospital. He has performed very difficult adjustments in cancer patients after cancer removal which requires significant artistry and ingenuity. Dr. Rizk also has a specialization in ethnic rhinoplasty. Many who seek this procedure require a reduction as part of the rhinoplasty procedure. In addition, Dr. Sam Rizk does nostril adjustments on patients with cleft lip/palate who tend to have very significant asymmetries and require major grafting and adjustments to make their nose and nostrils more symmetrical. Drawing on his wealth of experience, Dr. Rizk is able to adjust the conventional approaches while also creating unique modifications, so as to produce a natural-looking and rounded nostril with an inconspicuous scar located internally rather than externally.

Alar base reduction is done for nostrils that are too wide, and may be performed as an isolated procedure or in conjunction with rhinoplasty. There are certain guidelines for nostril position in comparison to the nose and other facial structures, but ultimately the surgeon’s artistry and vision for your nose determines if a nostril reduction is performed and how much is removed. Dr. Sam Rizk is very conservative with nostril reductions, since you cannot put them back to their original state. If Dr. Rizk performs an Alar Base Reduction during a rhinoplasty procedure and you want more taken out at a later time, this is an easy touch up procedure done under local anesthesia. These reductions can be performed on large or flaring nostrils or on asymmetrical nostrils. Dr. Rizk determines if nostrils are flaring based on an imaginary vertical line dropped from the inner part of the eye. The nose and nostrils should be within this vertical imaginary line. If the nose does not lie within this line, then a nostril reduction should be performed. Also, sometimes Dr. Rizk will perform a nasal reduction only on one side if one nostril is larger than the other. Sometimes nostrils are collapsing from previous nasal surgery and will require a cartilage graft to create a natural curved appearance and correct the collapsed pinched areas. Nostrils can also vary not just in size but also in thickness or horizontal insertion into the face, one being higher or lower than the other. These other variabilities in nostrils can be improved, although it is important to understand that complete symmetry is impossible in an already asymmetric nostril.

A Weir incision or a modified version of it can be administered internally on the nostril, while an incision given externally is more suitable for positioning along the curvature where the nose meets one’s cheeks. Dr. Rizk uses an internal incision in a modified type of Weir excision where he rotates the nostril to make them narrower in a natural position without a visible scar. Dr. Rizk does not perform external nostril incisions on the outside curvature of the nostril as the scars are usually very visible and may be difficult to hide. Dr. Rizk’s technique for nasal reduction is unique and has been developed over many years to minimize scars and achieve a natural contour to the nostrils.

The sill is the distance from the parting middle piece of skin separating the right and left nostrils (called columella) to the internal border of the nostril. Sometimes the sill is too long and makes the nose appear wide. If only the sill is wide and the nostril curvature is normal, then only a sill excision can be performed from a small internal incision to medialize or bring the nostrils closer to the middle part of the nose. Making an incision on the sill must be done with precision and delicacy to ensure that nasal airflow and respiration is not impaired. If both the sill and nostrils are large then a combined sill-nostril excision can be performed.

Dr. Sam Rizk performs an alar base reduction as the last part of a rhinoplasty procedure for several reasons. First, tip surgery can affect the shape of the nostrils, so the tip should be performed first. If the tip needs to be projected, this can bring the nostrils in more and make them narrower. If the tip needs to be deprojected or brought closer to the face, this can make the nostrils flare more.

No, Dr. Rizk removes the sutures around the nostril at the same time as the cast from the rhinoplasty is removed, one week after surgery. Dr. Rizk opts to use removal stitches rather than dissolvable ones in order to promote better healing results. The dissolvable sutures would leave little red dots as they dissolve, but the removable sutures do not leave a mark after removal.