27 Apr Wide Nose Rhinoplasty Part 2: Limitations

This post continues our discussion of wide nose rhinoplasty to discuss a very important concept: that there are limitations to wide nose rhinoplasty, in particular how much the nose can be narrowed and either still look natural and/or still breath normally.  We will discuss these issues below.

Wide nose reduction is an extremely common request in rhinoplasty in my NYC practice.  As mentioned in the previous post, rhinoplasty surgeons evaluate the nose in thirds.  There are different issues when addressing the wide nose in each third, but one commonality is that each third of the nose has an anatomical limit to how narrow it can become.

The first issue is purely aesthetic, which is to say that a nose should remain in harmony with the facial structure.  To achieve a narrow nose with a naturally wider facial shape is to actually worsen facial harmony and create a distracting appearance.  This has to be assessed based on individual, cultural, genetic and ethnic factors.  It really is the surgeon’s job to understand this aesthetic principle and be able to counsel patients about this important issue in wide nose rhinoplasty.

The second issue is anatomical.  There is a physical limitation to how much a nose can be made narrower from its more wide original shape.  This is because in order for the nose shape to manifest in real life or in photos, there needs to be some tension of the underlying bones and cartilage against the skin to create “definition” of the nasal features.  In wide noses there is also always more skin and soft tissue over the nasal cartilages and bones, and these will limit how visible the changes to the cartilage and bone are.  In fact, the over agressive surgeon runs the risk of removing too much cartilage or bone in an attempt to narrow the nose, which may create a breathing issue without actually achieving the narrowness that they were hoping for.

Despite these limitations, wide nose rhinoplasty is often very rewarding and can make a very nice change to the nasal appearance, if done correctly, especially with respect to the above limitations discussed. The takeaway here is that these issues are important to discuss with your board-certified plastic or facial plastic surgeon if you are seeking a wide nose rhinoplasty.