What can be done for my alar retraction? (Photo)

Question

What can be done for my alar retraction? 35yo, healthy. I've had a closed rhinoplasty 2016 then open rhinoplasty 2020 but the surgeon didn't fix the alar retraction from the initial closed surgery. (I did ask for it, he said he might do a graft when I am in surgery, but when I woke up he said it wasn't needed and as it heals it will improve but it's been like 3 years and looks the same...) Should I get an alar composite graft under local? Or fillers? Any and all suggestions welcome, Thank you

Selcuk Inanli, MD · Answer

Hello! Thank you for your question. From the photos you provided I can say that you have a very asymmetrical nostrils and hanging columella. Fillers would not be a solution also it can make worse than now and may be cause necrosis in your nose. For gain more symmetrical and elegant nose I recommend you open revision rhinoplasty. Your surgeon will use external grafts for the nostrils. Please keep in mind that %100 symmetry is not achievable in any cases. However, your nose can be much more harmonized with your face after the revision surgery. Best Regards!

Bora Ok, MD · Answer

Hello from Istanbul! Fillers would not offer a permanent solution. In any case, your alar retraction doesn't appear to be extremely prominent, while it might be beneficial to address the hanging columella. I would advise a reconstruction using a rib cartilage graft in your situation. Best of luck to you!

Christian Conderman, MD · Answer

Hi,
yes, it does look like you have retraction on the right side. This can happen with reductive rhinoplasty techniques when the lateral crus (outer part) of the tip cartilage is removed leading to scar tissue and upward displacement of the alar margin. A composite graft can lead to improvement in the symmetry of the nostril margin. I've had less success with filler and urge caution to patients who are considering filler after a nasal surgery as the vascular anatomy can be affected by the healing process. Hope that helps!

Mark G. Albert, MD, FACS · Answer

Hello,
Thank you for providing these photos. I think you're exactly right that alar composite grafts will help and there are also additional tweaks that can be done under local to improve symmetry.
Mark G. Albert, M.D., F.A.C.S.New York, NY

Andrew Miller, MD · Answer

Based on your photos, you are a candidate for a revision. If your nostrils were completely symmetrical before the initial surgery, then the cartilage making up the right side of the tip is either over resected or just weak. While there is no guarantee that surgery can fully correct it, placing a graft to fortify the lateral cartilage of the tip can often times improve things significantly. Be sure to see a rhinoplasty specialist for consultation.

Paul E. Chasan, MD, FACS · Answer

Thank you for your question.  A large portion of my practice is dedicated to rhinoplasty and revision rhinoplasty surgery.  Your particular anatomical issue is quite common.  I have found performing caudal septal excision and placing alar contour grafts-cartilage grafts along the rim have solved this problem in many cases.  You are an excellent candidate for this.  Best wishes to you.

Jeffrey Lisiecki, MD · Answer

The best treatment for this is revision rhinoplasty to reshape the tip and treat the alar rim retraction, including alar rim contour grafts to push the alar rim down.  Composite graft is typically unnecessary in a situation like this, and is not as aesthetically pleasing a result.  Fillers would not be appropriate to fix this, and injecting fillers in that part of the nose can be very dangerous.

Gianfranco Frojo, MD · Answer

I would recommend performing a revision rhinoplasty with additional cartilage grafts (including alar rim grafts to help with the alar retraction). I would highly recommend AGAINST any filler in the nose or composite grafting (these will not help with the problem). I recommend finding a board-eligible or board-certified plastic surgeon (not "facial plastic") with aesthetic fellowship training.

Samuel Lin, MD, FACS · Answer

Great question. Typically for patients with alar retraction it is important to understand prior procedures in planning for future treatments of the area. Those potential treatments could include cartilage grafts or other maneuvers...

Ronald J. Edelson, MD · Answer

Your skin iribkem is that you have a hanging columella so a lot of your nostril shows. That’s pretty simple to shorten up by trimming the lower edge of the septum. I see this all the time. Simple to fix

What can be done for my alar retraction? (Photo)

Answers (14)

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