Alar Rim Graft to Reshape Nostrils and Columella?

Question

I had 3 Rhinoplasties before since I had a very big nose. Dorsum has a silicone implant.Presently, I'm not happy with Alar/nostril thickess, shape (v round). My nose seems to be pointed up. Nostrils are seen very clearly.My doc told me that he can do alar rim graft, reduce the alar/nostril thickness and push the columella back.Can this improve my nose and not make the nose short? Also, can the angle be improved?

Philip S. Schoenfeld, MD, FACS · Answer

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.

Eric M. Joseph, MD · Answer

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.

David W. Kim, MD · Answer

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.

Scott Trimas, MD · Answer

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.

Toby Mayer, MD · Answer

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.

Steven J. Pearlman, MD, FACS · Answer

I agree that alar rim grafts can soften a dent or crease as the tip of the nose transitions to the nostril. The best source for this graft is the nasal septum.
Noses can also be made longer using strong grafts of your own cartilage. In that case it may require ear or rib cartilage to significantly lengthen a nose.

William Portuese, MD · Answer

It is very difficult to decrease the alar thickness. This is nearly impossible to do. An upturned nose can be pushed down. Alar rim grafts can bolster the sidewalls of the alar rim if they are flail and herniate in and downward. Composite skin grafts of both skin and cartilage can be taken from the ear and inserted up into the nostril rim to bring the alar rims downward so that there is less columellar show.

Nina S. Naidu, MD, FACS · Answer

With this many prior surgeries, each additional surgery becomes more challenging.  Alar rim grafts may help, but in the setting of scar tissue from your prior surgeries, this may not produce a dramatic enough result for you to justify an additional surgery. I would suggest seeing a surgeon who has extensive experience with revision rhinoplasty surgery in order to obtain an honest opinion about your possible results. 
Good luck.

Sigmund L. Sattenspiel, MD · Answer

You are currently seeking a fourth rhinoplasty. Each time a revision rhinoplasty is performed, there is a potential for improvement but there is also a potential for creating a greater deformity of the nose. Cartilaginous ala rim grafts are used to give a better structural contour to the rims of the nostrils. They will not necessarily reduce the thickness of the nostrils and they will not, by themselves, address the columella.

Richard W. Fleming, MD (retired) · Answer

Alar rim grafts can be used to improve the retraction of the notstil (alar) rims. If the nose "seems pointed up" cartilage grafts are necessary to lengthen the nose. It may be helpful to get a second opinion from an experienced revision rhinoplasty surgeon.

Alar Rim Graft to Reshape Nostrils and Columella?

Answers (11)

More Rhinoplasty Questions

WE SEND PRETTY
EMAILS

Answers (11)

More Rhinoplasty Questions

Horse Riding After Rhinoplasty?

Can a 17-year-old Have Rhinoplasty?

Rhinoplasty to Get Marilyn Monroe's Nose?

Cost and Financing Options for Ethnic Rhinoplasty?

Are There Risks in Flying After Rhinoplasty?

Filing Down the Dorsal Hump Without Osteotomy?

WE SEND PRETTY EMAILS

WE SEND PRETTY
EMAILS