How can I fix my alar notching? (Photos)

Question

I had a closed rhinoplasty about 13 years ago. It left me with uneven nostrils. I don't mind the size difference, but the difference in shape and obvious "notching" of my right nostril is extremely bothersome. Would a small amount of filler be able to smooth out the notch, and give me a result similar to the second picture which i have edited? Or is another surgery my only option?

P. Daniel Ward, MD · Answer

A composite graft (skin and cartilage graft) from the ear can be used to correct this issue. I recommend that you see an experienced rhinoplasty expert.

Farhad Rafizadeh, MD · Answer

Fillers can be used, but they have to be redone every year or two to maintain the results. A more permanent correction is a rim graft from the ear cartilage or the septum. If the examination shows that there is lack of skin lining of the inside of the nose, a composit graft of skin and cartilage can be used. An examination will confirm these recommendations.

Philip S. Schoenfeld, MD, FACS · Answer

The reason for your notching in the area of the soft triangle of the nasal alae is due to asymmetry and deficiency of the cartilages of the alar rims and tip.  I don't feel that a composite graft will be necessary to correct this issue as it does not appear to be scarred to the extent that the soft tissue in this area couldn't be released.  I would attempt an alar rim graft after re-aligning the nasal tip cartilages.  I think that a dermal filler would be a quick but very abbreviated fix.

Rodney A. Green, MD · Answer

The area where you have the notching is usually made up of only skin and does not have any cartilage support. This makes it difficult to maintain that extra fold of skin once it is contracted. If the skin is loose and mobile a small sliver of cartilage graft in that area may provide the necessary support to correct the notching. Otherwise some advancement of local tissue or bringing in of new tissue will be needed.

Ira D. Papel, MD · Answer

Asymmetry of the nostril edges is an issue which can be corrected. A filler agent may give temporary help, but would need to be redone every 6-12 months. Based on your photos using a small cartilage graft to correct the retraction (notching) of your left nostril would give you a long term solution. This as a stand alone treatment can be done with minimal downtime and discomfort. Remember that perfect symmetry of the nostrils is almost never present.

Prashant Soni, MD · Answer

the first thing is to have a plastic surgeon review the operative report. Occasionally a suture that has been placed to tighten the nasal tip at the first surgery can be removed to allow the alar cartilage to slide back into a more relaxed position. These type of sutures are often placed in open rhinoplasty , but can also be placed in closed types as well. If this is not the case then an alar rim cartilage graft is beneficial in many cases.

Eric M. Joseph, MD · Answer

Your photos show a slight asymmetry of the height of your nostrils. Depending on your condition, Permanent nonsurgical rhinoplastic treatments may be considered for improving nostril symmetry. Hope this helps! Dr Joseph

Richard G. Reish, MD, FACS · Answer

Hello and thank you for your question. Based on your
photograph, you may benefit from alar rim grafting.  This is a better solution than a filler and will provide a permanent result.  Make sure you specifically look at
before and after pictures of real patients who have had this surgery performed
by your surgeon and not just a computer animation system.
The most important aspect is to find a surgeon you are comfortable with. I
recommend that you seek consultation with a qualified board-certified plastic
surgeon who can evaluate you in person.
Best wishes and good luck.
Richard G. Reish, M.D. FACS
Harvard-trained plastic surgeon

Kenneth R. Francis, MD, FACS · Answer

Dear rms724,It is somewhat unclear as to whether a small amount of filler will correct your alar deformity.  It would depend on the quality and suppleness of the tissues in the area and whether your skin can stretch a little there.  It might be worth a try.  If ineffective, then you may have no choice other than surgery.  Good luck!

Reza Momeni, MD, FACS · Answer

I wouldn't call what you have severe alar notching, nonetheless, if it's something that bothers you, you could look into a temporary fix with non surgical rhinoplasty (filler), or a long term fix with revision rhinoplasty.  Without an exam, it will not be possible to fully evaluate you and give you recommendations.

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