Nostril cor­rection.

Our patients come to us with a wide variety of concerns: some would like narrower nostrils, others a correction of asymmetries or an adjustment that makes their nose look more proportionate. What they have in common is the wish for a natural, aesthetic result that complements their personality perfectly.

A precise analysis often shows that with a nostril correction the tip or other parts of the nose should also be corrected for a harmonious result. We model the result you want together with you on the Vectra 3D model.

What we colloquially call the nostrils is, strictly speaking, the entire alar base: the two alar walls, the nasal openings between them, the columella in the middle and the points at which the nostrils merge into the cheek and the upper lip. This area determines how wide a nose appears from the front — and when a rhinoplasty is planned it is often the last thing to be considered, even though it shapes the frontal impression more strongly than the nose bridge.

The base is carried by the alar cartilages, whose outer crura run into the alar wall. Further out, the nostril consists only of skin, connective tissue and fine muscles — without any cartilaginous support. This construction explains two things. First, the alar wall is mobile and can be drawn inwards on vigorous inhalation. Second, its width can be adjusted readily, because no load-bearing structure is altered here.

Four dimensions matter for the assessment. The width of the alar base in relation to the distance between the eyes. The degree of flaring of the nostrils — that is, how far they project sideways beyond their point of attachment. The thickness of the alar wall, which determines how much substance is present at all. And the height of the columella, because a columella drawn far down or sitting very high changes how much of the nasal openings can be seen.

These four dimensions are the reason why “nostrils that are too wide” can mean very different findings at the examination — and why the technique depends on which of the dimensions actually deviates.

At the alar base a principle applies that sounds contradictory at first: the less is taken away, the better the result holds. This is because substance and function are directly connected here. If too much is removed, the nasal openings become narrow, the alar wall loses its support and can be drawn inwards on inhalation. We therefore work very conservatively and to the millimetre at the base.

Narrowing the base. Through very small incisions in the natural fold at the alar attachment, a precisely measured wedge of tissue is removed. The attachment points thereby move closer together and the nose looks narrower from the front. The amount is determined separately for each side, because the two sides are almost always different. The incision is deliberately kept on the inner side of the fold, so that the scar lies in the natural shadow.

Adjusting the alar arch. If the nostrils flare sideways, the base is not narrowed; instead the arch of the nostril itself is altered. In this way the size of the nasal opening is preserved — which is decisive for breathing.

Thinning the alar wall. Where there is a great deal of soft tissue, the wall is carefully thinned from the inside. On the outside everything remains untouched and no additional scar arises. This tissue is slow to lose its swelling, so the result shows itself later here than with other findings.

Supporting instead of removing. If the alar rim is retracted or the nasal opening collapses on inhalation, fine strips of cartilage are inserted to hold the rim outwards. This measure improves form and breathing at the same time — taking tissue away would make both worse.

Suture techniques. For fine corrections of symmetry and of the position of the nostrils, very fine sutures that realign the cartilages are often enough. Shaping rather than removing is gentler on the tissue and more stable in the long term — the same principle by which we also stabilise the nasal tip in a cartilage-supported manner.

Which of these steps are necessary in your case is something we decide from the findings, and often only in the course of the operation, once the nose bridge and the nasal tip have taken on their new form. Because the operating theatres are our own, we operate without time pressure — this last fine adjustment needs calm.

The nasal opening is not held open by bone but by the outer crus of the alar cartilage and by the tension of the alar wall. This area is called the external nasal valve. If the cartilages are naturally weak, bent inwards or weakened during a previous operation, the alar wall is drawn inwards on vigorous inhalation and the opening narrows.

Those affected notice this above all during sport, when lying down and in cold air — and often help themselves unconsciously by pulling the nostril outwards with a finger. If this simple manoeuvre immediately improves breathing, it is a strong indication of a weak external nasal valve. Do try it, and tell us about it.

For the operation this means that the alar base must not simply be narrowed without examining this area. We assess the valve at every consultation and support it with fine strips of cartilage where needed — the same measure then improves form and breathing in one step. A correction of the nostrils that made breathing worse would not be a good result for us, even if the nose looked narrower.

The width of the alar base is one of the features that make a face unmistakable. We therefore do not treat it as a deviation from an ideal measurement but as part of your proportions. Whether an alar base looks too wide is not decided by a number but by its relation to the distance between the eyes, the width of the cheeks and the width of the mouth — and by your own impression in the mirror.

At the consultation we therefore first ask what bothers you, and not what deviates from a measurement. And we say so if we find that an alar base carries the face well as it is. A nose that is more delicate after the operation but no longer suits the face would not be a good result for us.

What we aim for is a change that preserves the character of a face. That is why we correct the alar base in millimetres, remain conservative when in doubt and deliberately plan this step last — once the bridge and the tip have taken on their new form and it becomes apparent whether the base still needs anything at all.

“A small correction, so a small procedure.” In terms of time, correction of the nostrils is the shortest part of nasal surgery — and nonetheless the least forgiving. Whatever substance is taken away here cannot be put back, and the effect on the frontal impression is disproportionately large. That is why we treat this step not as a minor matter but as millimetre work at the end of an operation.

“Wide nostrils can simply be cut away.” Together with the outer crus of the alar cartilage, the alar wall holds the nasal opening open. If it is narrowed too far, breathing becomes worse — particularly during sport and when lying down. How much is possible is therefore decided not by the wish but by function.

“My nose looks wide from the front, so it must be the nostrils.” Often it is the nasal tip or the middle third of the nose — and an isolated correction of the base would barely change the impression. This can be told apart clearly at the examination and in the frontal view of the 3D simulation. We will tell you if the cause lies at a different part of the nose than assumed.

A rhinoplasty with us takes one to four hours. This range is intentional: we operate in our own operating theatres and therefore without time pressure — for as long as it takes until every detail is right. How long a procedure takes is decided by the findings, not by the schedule.

In terms of time, an isolated correction of the nostrils is the shortest procedure on this page. Its part within a larger rhinoplasty, by contrast, comes at the end — and it is planned precisely when all the other steps have been completed. By then surgery has often been under way for a long time; it is exactly in this phase that time pressure is most dangerous, because millimetres and symmetry between the sides are what count.

That we are able to carry out this last section calmly is down to the fact that the operating theatres are our own. Nobody is waiting for the room. And what has once been taken away at the alar base cannot be put back — which is why we would rather adjust twice here than take too much once.

Age. For an aesthetic indication we operate once facial growth is complete — in women as a rule from about the age of 16, in men somewhat later. There is no upper age limit: what is decisive is the state of health and the quality of the tissue, not the year of birth.

Sun and season. With this procedure the season plays a greater role than with other rhinoplasties, because a scar may lie on the external skin and fresh scars can darken under UV light. Anyone who spends a lot of time outdoors in summer therefore likes to plan the procedure for the cooler half of the year — or is very consistent with sun protection in the first months.

As a procedure of its own or as part of a larger correction. If you are thinking about a rhinoplasty anyway, it makes sense to include the alar base in the same plan rather than addressing it separately later: one anaesthetic, one healing phase. If you are coming solely because of the nostrils, we will tell you honestly whether that is enough.

And the most important point. A correction is a good decision when it comes from your own calm wish. The width of the alar base is one of the features that make a face unmistakable — under pressure from those around you we advise against changing anything about it. The consultation about it is without obligation.

Readily possible is: an alar base that appears narrower in relation to the face. A degree of flaring that noticeably recedes. A marked asymmetry that is visibly softened. An alar wall that is less bulky. And a retracted alar rim that regains support — with better breathing as a side effect.

There are limits as well. The nasal openings have to remain large enough: narrowing is therefore limited, and more than a few millimetres per side is rarely sensible. Complete symmetry is hardly achievable at the alar base, because the two sides are naturally different. And a scar in the alar fold remains a scar — as a rule it is barely recognisable once healed, but we do not promise that it will be invisible.

What we advise against: an isolated correction of the nostrils when the actual reason for the wide impression lies at the nasal tip or in the middle third of the nose. And a very extensive narrowing, because it makes the nose look increasingly tight and contrived with age — and can impair breathing permanently.

An initial consultation with three-dimensional simulation, a technique that suits your nose, and an operating time that follows the findings — this effort is the reason why rhinoplasty with us has its price. It is also the reason why the result is meant to hold: for a lifetime, not for a few years.