5 years post op - Alar retraction surgery option? (Photos)

Question

I had a rhinoplasty 5 years ago and I am not satisfied with the result. My nostrils are uneven and are too visible. the bridge also isn’t smooth on one side it’s an uneven nose. Am I a candidate for revision surgery and what should I ask my new surgeon?

Randal Haworth, MD, FACS · Answer

At five years your nose has settled, so what you see now is a reasonable basis for planning, although photos cannot show the cartilage support underneath. Nostrils that look uneven and show too much from the side usually come down to rims that have been pulled upward (alar retraction), a columella that hangs low relative to them, or a bit of both. Rim retraction is commonly addressed with cartilage grafts along or beneath the rim, or a composite graft of skin and cartilage when the lining is short. A bridge that is not smooth on one side may reflect a residual bony step, a cartilage irregularity or an asymmetric osteotomy, and it is assessed on its own. Useful questions for any revision surgeon:1. Is the nostril show on each side coming from the rim, the columella, or both?2. Where would graft cartilage come from if the septum was already used?3. How many revision rhinoplasties do you perform, and may I see examples similar to mine?4. How will my breathing be protected?Candidacy is decided in person, so an evaluation by a board-certified surgeon who focuses on revision rhinoplasty is the right next step.

Richard G. Reish, MD, FACS · Answer

Hello and thank you for your question. Based on your photographs, you are a great candidate for a revision rhinoplasty. Maneuvers for your surgery would include nasal tip derotation, placement of extended spreader grafts, placement of extended alar contour grafts to treat the alar retraction, among other maneuvers. Make sure you are going to a surgeon with hundreds of long-term before and after pictures on their website with standardized lighting and standardized backgrounds. With good surgical technique, you could have an outstanding result. I recommend that you seek consultation with a qualified board-certified rhinoplasty surgeon who can evaluate you in person.

Best wishes and good luck.

Richard G. Reish, M.D. FACS
Harvard-trained board certified plastic surgeon

Best wishes and good luck.

Richard G. Reish, M.D. FACS
Harvard-trained board certified plastic surgeon

5 years post op - Alar retraction surgery option? (Photos)

Answers (2)

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