I have severe alar rim retracting on my left nostril caused by scarring inside of the nostril. I already had a revision in which a graft composed of ear cartilage was placed on the alar rim to try to bring down the nostril. This however did not work. In fact, it made the retraction worst. What are my options? I really need this fix. Also, I have no more ear cartilage left to harvest. It was previously used up revising a botched rhinoplasty.
Other Options for Fixing Alar Rim Retraction After Cartilage Graft Failed to Solve Problem? (photo)
Doctor Answers (5)
Alar rim retraction
Dr Fleming's comment is correct, but one alternative is to do nothing. Your retraction, based on the submitted photos, is not that noticeable. And remember that each surgery has risks, however small.
Other Options for Fixing Alar Rim Retraction After Cartilage Graft Failed to Solve Problem?
The retraction is really not that severe. Scar formation after surgery can create a tethering effect after primary rhinoplasty and in alar graft revision. You could do a composite graft, which would lead to possible additional asymmetry. You could also consider filler to this area to infuse the area of scar with a little more volume that can produce a nice long term effect even with a temporary filler. All of these have pros and cons, and you will have to decide what makes the most sense for you. Find a plastic surgeon with ELITE credentials who performs hundreds of rhinoplasties each year. Then look at the plastic surgeon's website before and after photo galleries to get a sense of who can deliver the results. Kenneth Hughes, MD Los Angeles, CA
Your retraction based solely on the photos does not look bad. However, a composite graft of ear cartilage and ear skin is usually the best method of treatment.
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Persistent Alar Rim Retraction
For cases such as yours the clear choice would be to use a mini-composite graft which is composed of both cartilage and skin. These grafts are harvested from the Cymba concha in the ear (a different place from where cartilage is typically harvested) and do extremely well. The operation can be done under local anesthesia using a closed technique and does not require any dressing or tape on the nose postoperatively.
Correction of Alar Rim Retraction
If previous placement of a cartilage graft did not correct your alar rim retraction you probably need a composite graft which includes both skin and cartilage. In 35 years I've never seen a patient that did not have enough skin and cartilage to correct a retraction like yours.