Alar Rim Retraction. Looking For a Surgeon?

Hello, I'm looking for recommendation to a rhino specialist. Specifically, I want to correct my moderate to severe alar rim retraction. I understand that this is one of the most difficult procedures and ty[cally requires either ear or rib cartilage. I'm not limited by funds or geography (other than the US), simply want to go to the very best doctor. I'd greatly appreciate comments from people who have successfully gone through this procedure or doctors who can recommend a specialist.

Doctor Answers 9

Correction of alar rim retraction

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Thank you for your question.  Before any discussions can be held concerning alar retraction it is very important to correctly examine the nasal tip as a whole to ensure that the problem is just alar rim retraction and  there is not an element of a "hanging columellar" present.  If the problem is truly a alar rim retraction this can be corrected by ether repositioning of the lateral crura of the lower lateral cartilage (the cartilage beneath the retracted rim or if necessary place a  lateral crural strut graft in the rim. It is rare to have to resort to using a composite graft from the ear.

 I hope this helps.

Donald M. Brown M.D.  F.A.C.S.

Board certified American Board of Plastic Surgery

Board certified American Board of Otolaryngology (ENT). 

San Francisco Plastic Surgeon

Fixing Alar Rim Retraction

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Dear David,

As you have mentioned, the corrective of alar rim retraction is a delicate procedure that could be approached through various ways depending on the level of retraction that can only be assessed by an in-person evaluation for the maximum possible accuracy.

Yes, you are right that cartilage grafts may be needed but the rib and ear are not the only donor places; septal cartilage if enough present will be a great source to harvest from.

Therefore, this brings us to mention that autologous cartilage grafting may not be the solution that will best fit your case but rather repositioning the lateral cartilage.

That being said, please remember that commendable results require an exceptionally skilled surgeon to perform the surgery and settling for anything less than that increases the chances of additional corrective surgeries dramatically.

I hope this helps and please feel free to check the website below.
Thank you for your inquiry.
The best of luck to you.

Dr. Sajjadian 

Ali Sajjadian, MD, FACS
Orange County Plastic Surgeon
5.0 out of 5 stars 205 reviews

Alar Rim Retraction

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Dear David,

I would be happy to have you send me photographs to the below listed email address so that I may give you my expert opinion. The answer really depends on the amount of alar rim retraction you have. You state moderate to severe which covers a lot of gray area in between. Typically lowering the lateral cartilages will improve the retraction. In many cases grafting may be needed which typically the graft site determination is based upon the thorough examination in consultation. This choice also depends on whether the rim retraction was caused from a previous Rhinoplasty or if this is your natural nose. In my practice these choices would typically be either septal cartilage or ear cartilage . Again please feel free to send photographs to my email address so I may provide further expert opinion. Best regards!

Michael Elam, MD
Orange County Facial Plastic Surgeon
5.0 out of 5 stars 218 reviews

Depending on your condition, a Non-Surgical Rhinoplasty may be employed to lower your retracted alar rims.

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I could provide better advice regarding your candidacy for an injectable filler treatment to lower your nostril margins if you post photos. In some cases, revision surgery with cartilage grafting is not necessary, and I have had good success with nostril lowering with Silikon-1000, an off-label filler for permanent results. I do not have experience with temporary fillers for this purpose, and temporary fillers may not be advisable for use in this area of your nose.

Hope this helps you.

Dr. Joseph

Eric M. Joseph, MD
West Orange Facial Plastic Surgeon
4.9 out of 5 stars 435 reviews

Alar Rim

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Every experienced Rhinoplastic Surgeon will tell you they are the best.  It is important that you find one by consultations who you can work with.  I think Rhinoplasty Surgery for lunch every day!

Robert Shumway, MD
San Diego Facial Plastic Surgeon
5.0 out of 5 stars 12 reviews

Alar Rim Retraction

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Alar retraction is most often caused by excessive resection of lower lateral cartilages and scar retraction. The best way to correct this is to reverse the process by lowering the lateral cartilages and addition of more cartilage over the existing ones if needed. Have not needed composite graft for this problem.

Mohsen Tavoussi, MD, DO
Orange County Facial Plastic Surgeon

Fixing alar retraction

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There are a few way so of treating alar retraction. This involves either an alar rim graft (best for more mild retraction), lower lateral cartilage repositioning (best for more severe retraction), or an alar composite graft (best if you're missing internal nasal lining from prior trauma or surgery).

You don't necessarily need to use ear or rib cartilage for this treatment since septal cartilage can work quite well for this. If you don't have adequate septal cartilage available (due to prior surgery) ear or rib may be needed.

Treating alar retraction is quite complicated so you would want to find someone well versed in addressing this condition.

Thomas A. Lamperti, MD
Seattle Facial Plastic Surgeon
4.9 out of 5 stars 22 reviews

Alar rim retraction

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There are relatively simple procedures available depending on the amount of retraction and whether it is from prior surgery or just the way your nose developed.  Most surgeons will use either septal cartilage from your nose or ear cartilage.

Leonard T. Yu, MD
Maui Plastic Surgeon

Corrrection of Alar Rim Retraction

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Unfortunately this is not an unusual problem, frequently present after a previous  rhinoplasty. A large part of my rhinoplasty practice is revisions - I did 2 patients like yourself in the last week. Most often I use ear cartilage or composite (cartilage & skin) grafts to lower the nostril rim.

Richard W. Fleming, MD
Beverly Hills Facial Plastic Surgeon
4.9 out of 5 stars 43 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.