Wide nose

A wide nose is one that looks broad from the front. The American Society of Plastic Surgeons (ASPS) lists nose width “at the bridge” and “the size and position of the nostrils” among the things rhinoplasty can change. The first step is to find out where the width actually sits, because the fix is different for each part.

Where can a nose be wide?

A nose can be wide in three places: the bony bridge, the tip, and the nostril base. Many noses are wide in more than one.

• The bridge. The two nasal bones and the side walls of the nose can sit far apart, making the upper nose look broad.
• The tip. Wide or rounded cartilage, or thick skin, can make the tip look broad. See bulbous tip.
• The nostrils. Flared nostrils, or a wide base where the nostrils meet the cheek, make the lower nose look wide. Cleveland Clinic lists nostrils that are too wide among the concerns rhinoplasty treats.

How does a surgeon assess width?

A surgeon assesses width by examining each part separately and photographing the nose from several angles. StatPearls lists photographs from the front, both sides, three-quarter, from below and from above. The view from below shows the nostril base and tip. The surgeon also checks the airway, because narrowing a nose can affect breathing, and examines the internal and external valves.

Ask the surgeon to point out on a photo of you which of the three zones is wide and by how much.

Which technique usually narrows a wide nose?

The technique follows the zone. StatPearls describes these:

Where it is wide	Usual approach
Bony bridge	Medial and lateral osteotomies: controlled bone cuts that let the surgeon move the nasal bones closer together. The lateral cut follows a high-low-high path and leaves a small triangle intact to support the external valve.
Tip	Cartilage techniques such as cephalic trimming and sutures. See tip rhinoplasty.
Nostril base	Sill excisions narrow the nostril base. Weir excisions address alar flare rather than base width. See alar base reduction.

StatPearls adds that sill excisions are usually small and the scar should be symmetric. It also says patients with very narrow nostrils and little alar curvature often need little correction, and that losing tip projection during an open approach can relax the nostril walls and make them look wider.

MedlinePlus says narrowing flared nostrils may leave small scars at the base of the nose that are often not visible.

Whether the surgery is open or closed depends mainly on the tip. Bone work can be done either way. If the septum is also bent, the surgeon may suggest septorhinoplasty.

What result is realistic?

A realistic result is a nose that is visibly narrower in the areas treated, in proportion with the rest of your face. It will not look dramatically different if the surgeon is working with your own skin and bone.

ASPS says that the aim is facial balance and correct proportion, and that everyone’s face is asymmetric to some degree. Results may not be completely symmetric.

Swelling hides the result for a long time. Cleveland Clinic says swelling falls slowly, with about 90% gone after three months, and full results usually appear after one year. See swelling month by month.

If your skin is thick, the tip may not narrow as much as the bridge. See ethnic and thick-skin rhinoplasty.

What can go wrong?

The risks are those of any rhinoplasty. Read the risks and complications guide. Three points are specific to width.

First, in a single-centre study of 732 closed rhinoplasties, the revision rate was 8.6%. Wide nasal bones and side walls were linked to higher odds of revision (adjusted odds ratio 3.94), and 37.1% of the revision group had a wide nose before surgery, against 15.6% of the comparison group. It is one retrospective study, but it suggests a wide bony vault is harder to correct to a patient’s satisfaction. The authors note the revision rate may be underestimated because follow-up was short.

Second, narrowing the bones can narrow the airway. StatPearls reminds surgeons to preserve support for the external valve.

Third, MedlinePlus notes that narrowing flared nostrils may leave small scars at the base of the nose, so ask where the cuts will be.

What to ask the surgeon

Ask which of the three zones the surgeon will narrow, and how. Ask how they will protect your breathing. Ask for photos of patients with a similar width, and ask how many such operations they do each year. See questions to ask a clinic and how to verify a surgeon.

How much narrowing is too much?

A modest change is usually safer than an aggressive one. StatPearls notes that osteotomies are planned so that a small triangle of bone is left to support the external valve, and that the nostril walls can be weakened by over-resection of tip cartilage. Narrowing that goes too far can leave the nose looking pinched or the airway tighter. Tell your surgeon if you already feel blocked on one side. They should check your breathing before the operation and explain how the plan protects it. Bring photos of noses you like, but also of noses you do not want, so that the conversation is about proportions and not about a single picture.

Next steps

If your nostrils are the main concern, read alar base reduction. If the tip is the problem, read bulbous tip. Then see the recovery day by day guide.