Composite Grafting for Retracted Nostrils?

I have been told that I need composite grafts using ear cartilage and skin to lower my severely retracted nostrils (after 2 surgeries). This sounds like a scary procedure. Is it safe? Is this something most cosmetic surgeons can do or should I go to a reconstructive surgeon?

Doctor Answers 3

Composite Grafts in the Nose

Composite grafts, which include skin and cartilage, are frequently used for alar retraction. Don't have any cosmetic surgeon do the work; select an individual who is experienced in revision rhinoplasty.  You've already had two operations - try to make this your last.

Beverly Hills Facial Plastic Surgeon
4.9 out of 5 stars 39 reviews

Grafting is a good solution for retracted nostrils

Dear Sara,

Grafting cartilage and mucosal tissue to the alae can help with alar retraction (retracted nostrils). The cartilage provides internal support for the nostrils and the mucosal graft allows the bottom edge of the nostril to move inferiorly (down.) The harvest of cartilage and mucosa is not a particularly dangerous or "scary" operation. The donor sites often heal without obvious sequelae and are not particularly painful in the postop period.

Since you have had two previous surgeries, you also have scar tissue in the nostrils, and so while the grafting is a good solution for your problem, the revision procedure can be somewhat unforgiving. In other words, the surgery has to be done just right to achieve the result for which you are hoping.

Most cosmetic surgeons are recontructive surgeons and vice versa. What you should do is seek out a few opinions, and seek especially a surgeon who has experience with revision rhinoplasty.

Good luck!

Tanuj Nakra, MD, FACS
Austin Oculoplastic Surgeon
5.0 out of 5 stars 24 reviews

Composite grafts work well.

Actually, composite grafts (and yes, they are skin and cartilage, not mucosa and cartilage when used for this purpose) can work very well.

But because retracted nostrils or alar notching are difficult to correct, the first step is an accurate diagnosis as to why the nostrils appear the way they do. If, after two surgeries so far, you haven't had much success, it makes me wonder whether the problem has been adequately evaluated (such as a hanging columella) and whether proper choices for correction have been make. Sometimes, for example, alar batten grafts and rim grafts may be required in addition to composite grafts.

As far as "is it safe" goes, it's no more or less safe than any revision rhinoplasty. But I would suggest that anyone looking at fixing such a problem should see someone whose major practice focus is rhinoplasty.

All the best,


David C. Pearson, MD
Jacksonville Facial Plastic Surgeon
5.0 out of 5 stars 25 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.