Dr. William Portuese in Seattle, Washington. And today we’re gonna talk about narrowing a wide nose with closed rhinoplasty. Patients notice the more narrowness, the moment I take the cast off. So the moment I take the cast off, patients can see their new bridge line which is narrower because it’s been narrowed, and then the cast has been applied across the bridge of the nose for a week. Once I take the cast off, patients can see their new bridge line immediately which is more narrow, but the tip itself is very swollen ’cause the tip does not have the cast on. So the tip’s swollen, but the bridge, they see that immediately. And especially patients who had a crooked nose, or crooked nasal bones, the first thing they see is their nose is straight. And that’s a very common theme we hear on a daily basis when we take the casts off the bridge line of the nose. The nose is straight and narrow. Most patients state that they don’t like the width of their tip, the width of their nostrils, or the width of their nasal bones. Their nose is just too wide. And so, many occasions what we do is we’ll narrow the nasal bones with osteotomy, that’s making cuts in the nasal bones themselves, and then just narrowing them in a tripod fashion. And then the corresponding upper lateral cartilages also getting narrowed, and then we can narrow wide nostrils as well. That’s called alarplasty procedure. That involves little incisions right at the nostril sill right here to narrow wide nostrils. To narrow the wide nose, we usually are performing a hump removal first. The hump is shaved down off the top of the bridge, and then the nasal bones themselves have to be narrowed to prevent an open roof flat top nasal deformities. We have to narrow the nasal bones and the corresponding upper lateral cartilages in the mid portion of the nose, otherwise the nose will be out of balance. Full healing after a rhinoplasty takes approximately a year. Depending upon the techniques performed, the skin type, whether there was cartilage grafting, or bone work, the tip of the nose stay swollen for quite a period of time. Usually about 70 to 80% of the swelling is gone on the first month or two. And about 90% is gone at three months, but full healing does take a year when you’re talking about narrowing and making cuts in the nasal bones and then narrowing the nasal tip cartilages as well. So if the nose is too wide, it tends to be the main focus when people look at your facial features. So if we can just refine the nose, it’s still the patient’s nose, it’s still their own skin bone and cartilage, however, if we can narrow and refine the nose, then the nose just blends in to the facial features and is not the most prominent feature on a patient’s face. Many patients ask their rhinoplasty facial plastic surgeon or make a statement that they don’t wanna look like someone else. They just want to look… That they want their nose more refined.
And I tell patients that, Rhinoplasty is a surgery that’s performed in millimeters, millimeters of changes. So there’s not a huge change that’s going to occur. Even when we take a large hump down on the bridge of the nose, that may only be a four or five millimeter hump. That sounds like a lot, and it is, but the swelling takes such a long period of time to settle down. And most patients, their friends don’t notice. They don’t notice the fact that they’ve had something done, they just notice, maybe it’s a new hairdo, or new makeup, or you lost some weight. They know something’s a little bit different. But many patients when they see their parents six months later, three months later, or their family and friends, and even many times, their own family members don’t notice that they’ve had a nose job done. They just noticed the patient looks better. But they can’t quite put a finger on exactly what the change was. And I had a girl in today, she went home for Thanksgiving. And her own parents, I did her about a month ago. Her own parents didn’t even notice she had a nose job done, and it was a pretty big change. So this is a patient that we narrowed a wide nose. Now she also had a dorsal hump present, so I shave down the dorsal hump. And then you have to, it’s mandatory that you have to narrow the nasal bones to prevent this flat top open roof nasal deformity. So we narrow the bridge line, and we narrow the nasal bones and the corresponding upper lateral cartilages in the mid portion of the nose. And then the tip cartilages themselves can be refined a little bit by just a very conservative removal of cartilage in that tip that can just create a little bit of feminization, a little bit of refinement, so it’s not so bulky, so wide, and so bulbous. And so, that ends up narrowing the entire bridge line, if you will, that narrows the whole nose. And that nose then is better fit with their facial features. And it just blends in rather than being the most prominent thing on their face. This patient underwent osteotomies placed in the nasal bones after I removed the hump, and then I took a small conservative amount of cartilage out of the tip of her nose. These photographs are about six months after the procedure. And it takes that amount of time for the swelling to come down and to see the final result. Learn more about narrowing a wide nose through rhinoplasty.