Dr. Sam Lam Plastic Surgery Forum

Dear Dr. Lam,

One of the biggest things that I dislike about my nose are my nostrils. As I'm looking forward or taking a profile picture, my nostrils are showing. Another thing I dislike about my nostrils is that they are too big.

I have no problem with my side profile, it looks perfectly fine. If I were to lengthen my nose and decrease the size of my nostrils, is it possible to keep my side view the same? Or would it make my nose longer and bigger?

Can a procedure be done by using ear cartilage to lengthen the tip a bit? What kind of rhinoplasty technique would you recommend for upturn noses?

Thank you so much!

ok, obviously, all we can do is talk in generalities. the key with a large nostrilled nose is to do several things:
1. not to do a traditional dome binding suture that will upturn the nose more. this is a traditional "Western" technique. i have lectured on this.
2. i give you tip refinement instead by placing a shield and tip graft that will hopefully lower the columella portion and create the illusion of de-rotation (dowturning) of the tip and hopefully in many cases the nostrils are less visible. but it will lengthen the tip so that is something i would have to see you in person to help you understand fully if that would or would not benefit you.
3. nostril reductions are fraught with issues. a nasal sill reduction is easy and reduces nostril show but can further round a nostril. a sheen flap can reduce the flare of a nostril but lead to prolonged visible incision line at the point of reduction. whether to do that to help your nose or hurt your nose depends on how the sides relate to the center. i would say in 70% of patients that reducing the sides will actually make the tip look bigger. everything is about balance. i would have to see you to decide.
i know those are generalities but hopefully a good start to understanding my thoughts of the asian nose.
best,
sml