I just went for an appt with my doc with issues regarding my upturned nose. My concern is the flaring nostrils. I just wan it to be less visible. My doc recommended me the Alar Rim Graft. He explained it to me in details however i still have a lot of questions on my mind? Is Alar Rim graft suitable for me? Is it effective? How much can the alar graft bring down my openness?
Is Alar Rim Graft Suitable for Asian Male?
Doctor Answers (15)
Alar rim graft ?
Once your nose is lengthened during surgery, only then your surgeon can adequately assess you for need of alar rim graft. adjustment of the tip and the length of the nose can significantly alter the alar show, thus this decision should be postponed.
Options for reducing nostril show during rhinoplasty
There are a few different approaches to reduce nostril show. If you are happy with the other angles of your nose, then adding composite grafts - little pieces of skin and cartilage taken from your ears - to your rims can help to lower them without altering the other aspects of your nose.
Treating the short nose with flaring nostrils
For the short nose, you'll need an extension graft to push the tip lower - either a septal extension graft, an extended columellar strut, or a braced shield graft - all of these are to push the tip down.
An alar rim graft will prevent kinking in the nostril if you narrow it or if you lengthen the nose. You may need it as part of the nasal lengthening and nostril procedure, but it alone will not lengthen a nose.
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Alar rim graft may be useful
There really is no straightforward answer here. First of all, there is no way to definitively answer your question from analyzing one photo. Planning for a rhinoplasty comes from careful evaluation of all views, not just a frontal view (i.e. your photo). You may or may not benefit from alar rim grafts. If you indeed have any alar retraction, then I can tell you that alar rim grafts will benefit you. And if your nose requires any lengthening, then retraction of the ala can result. In these situations, either an alar rim graft or a composite graft (less commonly) is needed to maintain an appropriate alar-columellar relationship. I apologize if this answer is too technical, but the bottom line is that this question is far too complex to answer without a physical examination and more photographs. I hope this helps.
Alar rim graft for flaring nostrils
Alar retraction is best treated with a composite graft of both cartilage and skin harvested from the ear. The graft is inserted on the inside of the alar rim to bring it down. A collapsing inward alar rim is best treated with alar rim grafts harvested from the nasal septum or ear cartilage.
Alar Rim Graft to Lengthen Nose
You do not need alar rim rafts - they will not lengthen your nose. A cartilage graft placed at the end of your septum will increase nasal length.
Alar rim grafts
After 30 years experience and 3000 rhinoplasties I'll simply say this ... Alar rim grafts are one of those things (Operations) that sound good and make intellectual sense but in reality never turn out good or make a difference. I have done alar rim grafts on at least a dozen patients and have been dissappointed on all of them. Either I made little difference for their effort and cost or the good result dissappeared over a period of 18 months from thinning and resorption of the cartilage graft
Prior to embarking upon this procedure, I would consult several of the most experienced plastic surgeons in your area. After all, you face is what you present to the public every day. I don't think an alar rim graft has a place here. You photo indicate a slightly upturned nose. One of the ways to correct this is to to add nasal length. This may be achieved through the use of spreader grafts and tip grafting. Cartilage is harvested from your nasal septum, ear, or ribs (rarely). This is placed along the dorsum (bridge) of your nose to help it point downward. Occasionally, cartilage tip grafts may provide improvement as well. Good luck. Take your time making your decision. Revisions are frequent in rhinoplasty, and it would be ideal to avoid one.
Green, Yellow, Red
I think of rhinoplasty in terms of level of difficulty as being green, yellow and red. Your picture looks like a classic Asian nose for the most part.
From what I can tell in the frontal pic the tip of your nose appears to be short with the tip of the nose being elevated. This picture looks like you may have had a rhinoplasty augmentation to the upper part of the nose. It would be helpful to know whether you've had a previous rhinoplasty. Without that information I would classify your nose as a red case.
Based on the photo you provided and not knowing your previous history, I would not likely recommend an Alar Rim Graft in your case. To address your concerns about "flaring nostrils" and decrease the openness of the nostrils I would recommend lengthening the nose by lowering or "derotating" the tip.
In my mind I'm using an Alar Rim Graft as a tool to help lower the nostril rim when only the rims are high in relation to the tip. This doesn't appear to be your issue. If I want to lower a significantly high or even notched nostril rim, I will even use a cartilage graft with skin attached to it and carefully place this on the inside of the nostril. Conceptually both of these approaches are non-anatomic in that we normally do not have cartilage in the nasal rim.
A consultation with an experienced surgeon that truly has a passion for challenging or "red" cases is the next step I would recommend. Look for a plastic surgeon who thoroughly understands nasal anatomy, as well as your goals.
Hope this helps.
Alar Rim Cartilage Grafts do NOT correct Nostril Flaring
Regarding: "Is Alar Rim Graft Suitable for Me? I just went for an appt with my doc with issues regarding my upturned nose. My concern is the flaring nostrils. I just wan it to be less visible. My doc recommended me the Alar Rim Graft. He explained it to me in details however i still have a lot of questions on my mind? Is Alar Rim graft suitable for me? Is it effective? How much can the alar graft bring down my openness?"
From the single photograph you submitted it is impossible to advise you with any sense of accuracy if you "need" an alar rim graft.
An Alar rim graft is usually used in revision nose surgery to correct notching and collapse of the nostril on inspiration. It is NOT used to de-rotate a nasal tip or correct nostril flaring.
You really should see more than one Plastic surgeon and if you hear different opinions you must realize than there may not be a solution for what you are asking and re-consider having your nose operated on.
Dr. Peter Aldea
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.