Which Nostril Grafting Method is Better?

I had retracted nostrils even before my surgery, not as a result of it, but am only deciding now that I want the nostrils lowered. I have gotten conflicting opinions from two different surgeons on how this should be addressed. One suggests that composite auricular grafts are best for alar grafting. The other doctor says that auricular grafts wouldn't be ideal and that septal cartilage would be necessary to graft the nostrils. I am trying to figure out which route is best. Please help me.

Doctor Answers 8

Grafting Techniques for Retracted Nostrils

Retracted nostrils can be both congenital (born with that particular shape) as well as a result of previous nasal surgery. The nostril rim (ala) is anatomically weak (lack of cartilage support) and has a tendency to "retract" or "notch" if not properly treated. Patients who possess this prior to any surgery are at a high risk for worsening after surgery and preventative measures are often best.

The treatment is variable and frequently depends upon the specifics of the problem, how much skin remains and if there is sufficient cartilage within the nose to correct the issue. It is not uncommon to go a step further and use rib or ear cartilage as a source of additional grafting material in "secondary" or "revision" surgical cases.

Regardless, both are acceptable techniques to correct this problem, and a secondary discussion with your surgeons may help you understand why one technique makes more sense in your particular case. Communication is one of the most important factors you must have with your surgeon prior to any cosmetic surgical procedure. And, ensure that the surgeon you choose has significant experience with secondary rhinoplasty, as it is the most challenging of any cosmetic surgical procedure.

Vincent Marin, MD, FACS

San Diego Plastic Surgeon
5.0 out of 5 stars 46 reviews

Retracted nostrils and grafts to lower them

With alar retraction, the best method to bring down the alar rim is with composite auricular grafts, which are composed of both skin and cartilage. These are harvested from the ear and inserted on the inside of the nostril rim to bring the alar rim and nostril rim down. If the alar rim is collapsing on inspiration, a simple cartilage graft from the nose is the better grafting method, and this is called an alar batten graft.

William Portuese, MD
Seattle Facial Plastic Surgeon
4.8 out of 5 stars 143 reviews

Nostril(Alar) Retraction

With minor nostril retraction (2mm or less) cartilage from the ear or the septum works very well. If there is 2-4mm retraction, a composite graft from the ear is necessary. For those not aware, a composite graft is both skin and cartilage. Therefore the answer to your question depends on the extent of the retraction.

Richard W. Fleming, MD
Beverly Hills Facial Plastic Surgeon
4.9 out of 5 stars 38 reviews

Alar Retraction

Septal cartilage is definitely stronger than auricular cartilage. This is why many surgeons prefer to use septal cartilage. However, sometimes the septal cartilage has been removed or is not enough, then auricular cartilage can be harvested as well.
Both cartilage should be adequate to augment the nostrils, I would start with septal cartilage.
Dr. S.

Oleh Slupchynskyj, MD, FACS
New York Facial Plastic Surgeon
4.8 out of 5 stars 272 reviews

Nostril retraction

The treatment of nostril retracation all depends upon the extent of the retraction. If it is minimal, cartilage grafts alone are reasonable. If it is significant composite grafts are better.

Steven Wallach, MD
New York Plastic Surgeon
4.1 out of 5 stars 28 reviews

Alar retraction and treatment

I agree with the comments of the other physicians below. Minor degrees: 2mm of alar retraction can likely be treated with septal grafts whereas more significant amounts will require a composite graft in order to provide sufficient lining.

Otto Joseph Placik, MD
Chicago Plastic Surgeon
4.9 out of 5 stars 81 reviews

You don't have to choose the technique, just the surgeon.

As with so many things in surgery, there are different ways to achieve the same result. If alar retraction is severe, correction requires adding skin, too (e.g., a composite graft or skin graft plus rim graft), whereas correction of more minor retraction may require rim grafts of septal cartilage alone. And the options don't stop there.

BUT! You don't need to choose the technique! You need to choose a surgeon who gets good results with his/her own techniques. Choose someone whose practice emphasizes rhinoplasty, who's properly credentialed, and who has a decent array of before and after photos. And make sure you get a good feel from the surgeon and his staff. I know that last one is the least "hard" as data goes, but it's also a factor.

All the best,


David C. Pearson, MD
Jacksonville Facial Plastic Surgeon
5.0 out of 5 stars 24 reviews

Nasal Alar Retraction Correction, Which Graft is Best?

Hi Volcanic,

Don't blow your top over the decision.

It depends on the extent of your alar retraction. If it is mild then nasal septal cartilage grafts can lower the ala enough to avoid the more complex procedure of composite auricular grafting which is used for when more correction is required.

Good luck and enjoy your new nose.

Dr. P

Michael A. Persky, MD
Encino Facial Plastic Surgeon
4.8 out of 5 stars 36 reviews

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.