I want to have an Alar Rim Graft and a Tongue-In-Groove(TIG) surgery. I have had a Rhinoplasty(2004), including having my columella trimmed(06/2011. I am happy with my profile but from the front I feel my nostrils still look retraced and I still feel my columella hangs, especially when I smile. Should I? And are these surgeries best?
I Want to Have an Alar Rim Graft and a Tongue-In-Groove (TIG) Surgery?
Doctor Answers (9)
Alar rim graft
Alar rim grafts are only used to prevent the alar rims from collapsing upon inspiration. They do not actually bring the alar retraction down. Composite grafts, which are composed of both cartilage and skin are grafted on the inside of the nose and can actually bring the alar retraction down for a better alar columella relationship. If there is a hanging columella upon animation and smiling, release of the depressor septi muscle should be done at the time of revision rhinoplasty.
Alar Rim Graft and Tongue-in-Groove surgery
A profile picture would be helpful in answering your question. However, an alar rim graft is effective in treating alar retraction and the tongue-in groove procedure will raise a hanging columella. Obviously the final decision should be made after careful evaluation. Both procedures are reliable and relatively easy for the patient.
Alar rim graft and tig surgery, slow up a little
Both are good procedures. Wait until you recover from one procedure before moving on to something new. You really need to speak with your surgeon about the things you are observing in your nose.
I hope this information has been useful to you.
Jon I Sattler, MD, Board Certified Plastic Surgeon, Glendora, California
You might also like...
Treating alar retraction and hanging columella
Alar rim grafts and Tongue in Groove setback of the columella are both great techniques to treat alar retraction and hanging columella, respectively.
Whether or not they are the best option for you is a little hard to say without seeing additional views of your nose (esp profile). From your frontal view you do appear to have some alar retraction. If you just had your columella shortened last month it may be a little hard to assess your nose right now, though. In some instances alar retraction can lead to a perceived columellar retraction, but improvement of the ala alone may be the best treatment.
Alar rim grafts are one option for improving retracted ala, but generally can't improve retraction more than a couple millimeters. More significant retraction can be treated with lower lateral cartilage repositioning. This is a very powerful technique, but not all rhinoplasty surgeons are comfortable with this so be sure to find a surgeon well versed in such advanced maneuvers.
Alar rim graft
It's really hard to make any recommendation from the photo you posted. Alar rim grafts can prevent alar collapse and lower the rims perhaps 2mm.Other types of grafts or techniques are needed to provide more lowering when there is significant alar retraction. Tongue in groove is a powerful tool to treat hanging columella when there is some excess caudal septum or bowed convex medial crura. Your photo suggests that a TIG would shorten your nose and create hooding. If these are photos from a procedure last month you may still have swelling of your columella. You need to talk to your surgeon more about your expectations.
You may consider a well-performed Injectable Filler procedure to lower your nostrils after previous Rhinoplasty Surgery.
I read your concern and reviewed your photos. In my view, a second revision rhinoplasty surgery should be a last resort. You appear to have a pleasing nasal appearance, and I see you have slight nostril retraction. I have had good results lowering nostril margins with Silikon-1000, an off-label filler for permanent results.
You might need several treatments for complete correction. Your results with injectable silicone can vary, but in general, soft, retracted nostril margins tend to lower with Silikon-1000 treatments.
You should only use a physician experienced in the delicate use of Silikon-1000 for non-surgical rhinoplasty procedures.
I hope this is helpful for you.
The tongue-in-groove technique is an excellent way to address a hanging columella. However, based on the frontal photograph shown, it is hard to see whether of not this is a problem for you. The alar retraction that I do see may be related to previous resection of the lower lateral (nasal tip) cartilages. Sometimes alar retraction gives the appearance of a relative hanging columella. This problem can can be addressed nicely by alar rim grafts, and possibly by rebuilding the LLC's with cartilage. However, these are advanced techniques that may not work well in everyone's hands. Experience counts in revision Rhinoplasty. Good Luck.
Revision rhinoplasty techniques
It is hard to evaluate your nose from the limted-view pix you submitted. What I can see is that your tip is a little wide and lacks some definition.
Revision rhinoplasty is much more complex than it seems due to scarring and limitation of blood supply. In general, less is more.
Make sure your surgeon has broad experience in this arena and that he or she understands exactly what your goals are, both at rest and when animating. Subtle adjustments of the alar rim can be accomplished with small cartilege grafts, but some skill is needed to provide perfect contours. I would probably recommend some more tip support to provide a finer shadow and better tip length to nasal base proportionality.
Be sure you wait at least a year after your last procedure before considering a revision.
These answers are for educational purposes and should not be relied upon as a substitute for medical advice you may receive from your physician. If you have a medical emergency, please call 911. These answers do not constitute or initiate a patient/doctor relationship.