Asymmetry and alar retraction - What is the least invasive procedure to fix issues and make it aesthetically pleasing? (Photos)

Question

Female, 39, primary rhinoplasty in 2021. Now I am concerned with alar retraction, asymmetry and columelar over projection. Is the asymmetry very noticeable? What is the least invasive procedure I can do to fix issues and make it more aesthetically pleasing?

Eric M. Joseph, MD · Answer

If you would be content with several millimeters of nostril lowering on front view, microdroplet Silikon-1000 nasal injections maybe considered for decreasing your nostril show on front view. I do not think this would do much for your profile nasal tip appearance. I hope this is helpful. Sincerely, Dr Joseph

Ajaya Kashyap, MD · Answer

Thank you for your query. The best way to fix alar retraction and the minor asymmetry at this stage, without having to have a full revision, is to have injection of fillers. Hyaluronic acid fillers that last for two years in other parts of the face, tend to last a lot  longer in the nose. Please discuss this with your surgeon who can examine you and help you with all your concerns. All the best!

Ramin Behmand, MD, FACS · Answer

Assuming you're generally happy with the overall outcome of your rhinoplasty in 2021, the alar retraction can be addressed in a relatively conservative way. The right side does appear slightly more retracted than the left. This can typically be improved using alar rim grafts, placed through internal incisions to avoid visible scarring. These grafts help support and restore the contour of the nostril rim, creating better symmetry and a more balanced appearance.

-DrB

-DrB

Kyle Kimura, MD · Answer

Thank you for the question and the photos. 
I think the first thing that I notice in the pictures is your alar retraction or "notching" of the nostrils (one side worse than the other). This is something that can be improved through a minimally invasive procedure. This involves getting a piece of cartilage and skin from the ear and placing on the inside of the nostril to lower/decrease the amount of notching. I think this could also help a bit with the appearance of the columella, as I don't think the issue is that this is too low/overprojected, but rather looks that way because of the ala/nostrils. 
I think your best bet is to schedule a consultation with someone who specializes in rhinoplasty and whom you feel comfortable and confident with. 
Hope this helps and I wish you the best of luck! Kyle Kimura, MD

Andrew Miller, MD · Answer

Based on your photos, you are a great candidate for revision rhinoplasty. The tip droop needs to be lifted, which helps columella show. The tip is also too wide, and this can be refined during a revision, while trying to push the nostrils down at the same time. Be sure to see an expert rhinoplasty surgeon for consultation.

Guray Yesiladali, MD, FEBOPRAS · Answer

At this stage&mdash;several years post-op&mdash;it's understandable that you're reassessing your results and noticing details like alar retraction, columellar projection, and asymmetry. These concerns are relatively common after rhinoplasty and can often be improved.
Is the asymmetry very noticeable?Photos can help, but even with those, a definitive judgment requires an in-person evaluation. Minor asymmetries are quite common and often not obvious to others. That said, even subtle differences can feel significant to you&mdash;and your concern is valid.
Least invasive options to improve appearance:Filler (Liquid Rhinoplasty): In some cases, hyaluronic acid fillers can be strategically placed to balance minor asymmetries or camouflage mild alar retraction. However, this is a temporary solution and less effective for structural issues like significant retraction or columellar over-projection.
Alar Retraction Correction (Cartilage Grafts): If retraction is more pronounced, composite grafts (typically from ear cartilage or soft tissue) are often used to restore contour. This would require revision surgery but can be tailored to be conservative.
Columellar Adjustment: Columellar over-projection is usually corrected with revision rhinoplasty, adjusting cartilage support. A subtle revision focusing only on this area might be possible if the rest of the nose is stable.
Since you’re seeking the least invasive approach, a good first step is a consultation with a surgeon experienced in revision rhinoplasty. They can assess whether a nonsurgical option is appropriate or if a limited surgical revision would offer better, lasting results.
I hope this helps guide your next steps. A personalized evaluation will provide the clearest path forward.
&mdash; Güray Yeşiladalı, MD

Richard G. Reish, MD, FACS · Answer

Hello and thank you for your question. Based on your photographs, you are a great candidate for a revision rhinoplasty. Maneuvers for your surgery would include placement of extended alar contour grafts to treat alar retraction and tensioning of the tip , among other maneuvers. With good surgical technique, you could have an outstanding result. I recommend that you seek consultation with a qualified board-certified rhinoplasty surgeon who can evaluate you in person.

Best wishes and good luck.

Richard G. Reish, M.D.
Harvard-trained plastic surgeon

Best wishes and good luck.

Richard G. Reish, M.D.
Harvard-trained plastic surgeon

Philip Michael, MBBCh, FRACS, FRCS(Ed) · Answer

Many thanks for your enquiry,
Alar retraction can potentially occur when the lower lateral (alar) cartilages that help to form the shape of the nostrils are reduced in size to in turn help to help shape the nasal tip. In your photos, the right side does appear to have retracted more than the left.There is a potential to lower these by adding graft material to the nostril "rims" via incisions on the inside of the nose. However, this would be better undertaken with someone specialising in rhinoplasty procedures rather than a generalist
Best Wishes

Cengizhan Ekizceli, MD · Answer

Thank you for sharing your photos and concerns. The asymmetry and alar retraction you’re noticing are subtle but valid, especially given your post-rhinoplasty history. The least invasive options to address this include: • Alar rim grafts (using cartilage) to correct retraction and restore a more balanced contour • Tip refinement with injectable fillers as a temporary, non-surgical option for mild asymmetry • Columellar setback or cartilage reshaping can be done via minor revision under local or twilight anesthesia
A minor revision rhinoplasty focused only on the external tip and alar base may provide lasting results without full surgical dissection. You’re likely a good candidate for subtle refinements with minimal downtime.

Darryl J. Blinski, MD · Answer

Based on your nicely post of photos, a revision rhinoplasty with cartilage grafting and nasal tip revision is indicated fee $15,000-$25,000. Best of virtual consult with.

Asymmetry and alar retraction - What is the least invasive procedure to fix issues and make it aesthetically pleasing? (Photos)

Answers (11)

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