Alar Rim Graft to Reshape Nostrils and Columella?

Alar rim grafts are quite useful for lowering the height of the ala, smoothing out the contour of the alar rims, and reducing the columella show on lateral view. The thickness of the ala can also be thinned. All of these maneuvers in rhinoplasty can have very nice results when everything heals just right, but, I would recommend caution in performing too many modifications of the ala rim at the same time. Thinning alar rims can lead to scarring and unwanted alar retraction even in the presence of rim grafts. I would suggest the rim grafts without too much alar thinning to help with contour.

I have had wonderful success in lowering the height of retracted nostrils following Rhinoplasty Surgery using Silikon-1000. Whenever I mention this permanent, Injectable Filler, I suggest finding a dermatologist or facial plastic surgeon experienced in the serial puncture, microdroplet technique of silicone injection.
In your case, I would try to lower the height of your nostrils, and fill the pinched areas where your nostrils connect to the sidewalls of your nose.
I am a passionate Rhinoplasty Surgeon, and I strongly suggest you avoid any further non-essential nasal surgery.
I've attached photos for your perusal.
I hope this is helpful for you.

I see the following problems in your nose:

1. Rounded, isolated tip

2. Poor transition from tip to nasal base (deep shadowing on each side of the tip)

3. Overly arched, retracted alar margins (nostrils show)

4. Over-rotated (up turned, short) nose

5. Thick alar side walls (nostril base)

6. Retracted columella and hooded ala

If you were my patient i would recommend structural cartilage grafting using septal or rib cartilage to lengthen the nose, push down the columella, strengthen the alar margins (yes rim grafts), and improve the transition from the tip of your nose to the base--restore triangularity and make the tip less isolated. I would also consider removing the implant and replacing with cartilage so as to minimize risk of infection.

Correcting nostril shape and thickness can be accomplished with cartilage grafts referred to as alar rim grafts when placed along the ala and nostrils. In addition, you most likely will need plumping grafts to the columellar labial angle to bring the columella forward as well as columella struts and perhaps septal extension grafts. This is based just on one view and other views could change the recommendations. If you have had previous rhinoplasties there probably is a paucity of cartilage left in your nose and you would most likely need rib grafting for structural support of your columella and tip but you might get by with conchal or ear cartilage. I would recommend a surgeon experienced in revision rhinoplasty. I hope this information helps.

 I would see an experienced revision rhinoplasty surgeon. If the doctor wants to do rim grafts, why weren't they done with the first surgery? Also you will need septal or ear cartilage grafts too lengthen the nose.