This is a very interesting question. The overall appearance of the nose must be considered. And, there are many factors to take into consideration. We begin with the overall structure of the patient including height, weight in skin thickness.
Then we must discuss very thoroughly with a patient their goals. Once we have a clear vision of the patient’s goals then we can devise a plan. There have been established over time, the ideal or optimal relationships that should exist in the nose- although with some flexibility, to maximize its elegant look for the female patient.
For the male patient, the goal is masculinity yet attractiveness. Keep in mind that the majority of primary RHINOPLASTY patients have larger noses, seeking reduction. Some patients have genetic deformities and are seeking improvement.
Also, some patients present for revision after unsuccessful RHINOPLASTY elsewhere. Each one of these situations requires a detailed analysis and establishment of the patient’s goals. It is rare for a primary RHINOPLASTY patient to present with a narrow nose and want to widen. However, this can occur in genetic situations.
RHINOPLASTY
All that said and keeping in mind the range of relationships that should be achieved we can then proceed with a surgical plan. In some cases, this plan may require cartilage grafting. If you recall from previous blogs, the sources for cartilage are the patient’s own ears, septal, cartilage, or the patient’s rib. I have found a majority of these to be insufficient inadequate or incapable of allowing me to achieve the best outcome. Therefore, I have been using more frequently fresh frozen rib.
This gives me the maximum opportunity to use as much material as I need to, to achieve the best outcome. Admittedly, it’s uncommon but possible for primary RHINOPLASTY but possible. We have achieved numerous elegant results for primary RHINOPLASTY patients using fresh frozen ribs.
More commonly revision rhinoplasty, which will need sufficient cartilage grafting in my opinion, is only achievable using fresh, frozen rib grafting. The ultra-narrow nose may have breathing problems due to valvular collapse, which responds successfully with cartilage graft.
This may improve the breathing of that patient – it is only achievable with this type of grafting procedure. Cosmetically for revision rhinoplasty that presents with an overly narrow nose this grafting technique in my opinion, is optimal.
Therefore, the answer is yes, noses may be widened, but in very specific circumstances, and in my opinion, optimally achieved with the use of allografting (not from the patient) cartilage material, preferably fresh, frozen from the tissue bank.
RHINOPLASTY is a very challenging procedure and requires extensive experience therefore, I suggest very carefully evaluating the surgeon before you make your decision. We have a lot of information you may find useful on our site as well as extensive gallery that will help you improve your gathering of information about this very important topic. Our goal is always to achieve the most elegant, attractive nose possible, therefore enhancing the patient’s life.
THOMAS TREVISANI, MD
BOARD-CERTIFIED PLASTIC SURGEON
MEMBER OF THE AMERICAN SOCIETY OF AESTHETIC PLASTIC SURGERY
