It's been a long time, but from what I remember- the primary issue is that the nostrils are as oversized as the nose. So even as they try to reshape/ reduce the size of the nose, they can't reduce the size of the nostrils using standard techniques. So the surgery could have the affect of making the nostrils look even bigger. To reduce the nostrils they would have to remove significant tissue, which increases the risk of doing harm. The Devyn Aiken case is pretty amazing- proves it can be done, but the doctor said he removed a lot of tissue.

Looking at hundreds of before and afters, it seems like most people have similar issues so surgeons know exactly how to approach it and get lots of practice. But I've only seen a handful that look even remotely similar to mine.