Rhinoplasty with Alar Base Reductions: Are they Reversible?

Written by Frank P. Fechner, MD

Alar base reduction is a procedure to narrow the nostrils. When performed, it ususally is done in conjunction with rhinoplasty. Sometimes, patients may wonder, if over-corrected narrowing can be repaired.

When planning alar base reductions, both patient and plastic surgeon should consider it irreversible!

Although creative creative reconstructive procedures can be considered by a rhinoplasty surgeon if the nostril narrowing was undesirable. Unfortunately, these revision surgeries routinely do not look very good, even in the best hands.

Therefore, Dr. Fechner carefully decides if alar base reductions are necessary. If they are performed, conservatism and exact execution of the procedure are of utmost importance.

Open and Closed Rhinoplasty Results and Plastic Surgeon’s Experience

Written by Frank P. Fechner, MD

Some patients report the observation that closed rhinoplasty result may be better than what they saw after an open operation. Does the rhinoplasty surgeon’s experience play a role?

It sure does!  Dr. Fechner stresses that the cosmetic outcome after nasal plastic surgery is not determined by the approach – open vs. closed.  Much more important is the careful examination of the nose, followed by the appropriate planning and exact execution of the rhinoplasty.

Either technique (endonasal or open) can lead to an excellent cosmetic results for almost every nose. Complex revision surgeries represent an exception: sometimes extensive reconstruction with cartilage grafting (often using cartilage from the rib) may become necessary.

Certainly, many plastic surgeons prefer one technique over the other. This is usually a reflection of the surgeon’s training, experience and comfort.

The choice for the rhinoplasty surgeon is best not be guided by the doctor’s favorite approach (closed or open) but by the patient’s comfort with the surgeon, his experience and prior results.

Rhinoplasty after Previous Septoplasty

Written by Frank P. Fechner, MD

Not uncommonly, patients come to see us for rhinoplasty who had septoplasty surgery performed previously in order to improve breathing difficulty. This septal straightening procedure may have been performed as part of a rhinoplasty, nasal fracture repair, sinus surgery or as a stand-alone procedure. It is important that the person interested in rhinoplasty informs the plastic surgeon about the previous procedure. Why? Because during a septoplasty, parts of cartilage and bone may have been removed which limits the remaining support of the nose. (I have seen patients who developed severe nasal collapse after over-aggressive septal surgery). In addition, additional cartilage for grafting may be necessary for the rhinoplasty to be fully successful. If the surgeon is surprised by missing cartilage during the rhinoplasty procedure, other sources (usually the ear) may provide the needed material and it is, of course, best to prepare this beforehand. Often, a careful examination by the rhinoplasty surgeon will show how much septal structure has been changed or removed during previous septoplasty.
Certainly, performing septoplasty and rhinoplasty as one procedure is best for the patient and this would be my preference. Because of the intricate relationship between septum and outer nasal appearance, staging the two procedures is suboptimal.

What is the approach to the bulbous nose?

Written by Frank P. Fechner, MD

Our modern approach to rhinoplasty rely on reshaping the nasal cartilages without compromizing the support. Only observation of these two goals will lead to an improved but normal looking nasal tip. Most of these rhinoplasty procedures we perform with the endonasal approach avoiding external nasal skin incisions. The pinched and “unusual” look needs to be avoided at all cost. Most patients who are seeking revision rhinoplasty had their procedures performed decades ago when much of the important cartilage was removed. This leads to pinched and collapsed noses and usually also interfers with nasal breathing making complex reconstructive rhinoplasty procedures necessary.