I Want to Have an Alar Rim Graft and a Tongue-In-Groove (TIG) Surgery?

asked 10 months ago by unsure82 in CA
Latest answer by William Portuese, MD
Question viewed 519 times
Tags: alar rim graft, columella, hanging

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?

9 answers to I Want to Have an Alar Rim Graft and a Tongue-In-Groove (TIG) Surgery?

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... more

William Portuese, MD
Seattle Facial Plastic Surgeon

www.seattlefacial.com

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.

Richard W. Fleming, MD
Beverly Hills Facial Plastic Surgeon

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

Jon Sattler, MD
Glendora Plastic Surgeon

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... more

Thomas A Lamperti, MD
Seattle Facial Plastic Surgeon

www.drlamperti.com

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... more

Michael L. Schwartz, MD
West Palm Beach Plastic Surgeon

www.palmbeachface.com

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... more

Eric M. Joseph, MD
West Orange Facial Plastic Surgeon

Rhinoplasty Maneuvers

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... more

Stephen Prendiville, MD
Fort Myers Facial Plastic Surgeon

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... more

Daniel Greenwald, MD
Tampa Plastic Surgeon

bayshoreplasticsurgery.com

Alar Rim Graft and a Tongue-In-Groove (TIG) Surgery

The combination of the Alar Rim Graft and a Tongue-In-Groove (TIG) Surgery is a good way to reduce columellar show and improve the alar-columellar relationship