How to correct alar retraction without invasive procedure? (photo)

Question

Hi there. I’ve had 2 rhinoplasty procedures 17 and 14 years ago. My right nostril is too high and I would like it corrected with grafting I assume. I do not want a full rhinoplasty procedure, I only want that right nostril corrected. I did try fillers a year ago and the nostrils did not lower, hence the redness around the nostrils. Is it possible to correct this without an invasive procedure? I am willing to travel. Thank you so much for your help!

Eric M. Joseph, MD · Answer

Thank you for this question. I see the redness at your nostril margins from filler one year ago, and I am surprised that you did not see any lowering at all. Based on your photos, I suspect that you have a hanging columella, and possibly a deviation of your nasal septum at the base, which may be causing nostril asymmetry. Unfortunately, the nonsurgical nose job did not work for you. Please consider meeting with several reputable rhinoplasty specialists so you can get an expert opinion.

Donald Groves, MD · Answer

Hello and thank you for your question and picture. You actually have a very difficult problem to correct- asymmetric nostrils with increased nostril show and a hanging columella after multiple prior surgeries! Unfortunately, a minimal procedure or revision surgery "just to the tip" will not be able to fix your issues- any surgeon that tells you otherwise is either inexperienced or is intentionally doing you a huge disservice. A revision rhinoplasty can best address your aesthetic concerns and any functional issues with your nose. I would be able to release all the scar tissue present, then adjust the size, shape, and especially the definition of your nose (particularly the tip and nostrils). I'd also be able to open up and solidly reinforce the underlying structural framework of your nose (to prevent distortion and retraction from scarring forces over time)!

Revision rhinoplasty is truly a surgery of millimeters- they are the most technically challenging procedures in all of plastic surgery! Because your nose is the DEFINING feature of your face- I would only recommend seeing a surgeon who specializes in revision rhinoplasty procedures, and who has significant training and experience performing these surgeries. I actually trained under one of the world leading revision rhinoplasty experts (who performs 1,000+ nosejobs annually).

If you are unhappy with the appearance of your nose, I recommend for you to setup a formal consultation with me (or another plastic surgeon who is extremely comfortable with revision rhinoplasties) to thoroughly discuss your surgical goals, undergo a formal examination, evaluate your options, and develop a personalized plan just for you. I hope this helps!

Dr. Donald Groves
Aesthetic Plastic Surgeon

Gianfranco Frojo, MD · Answer

Alar retraction/notching in your particular scenario would be best addressed with a revision rhinoplasty that would include alar contour grafts and possible shortening the caudal septum. This really depends on a physical exam with intra-nasal and extra-nasal examination. You would likely need a rib graft (either from yourself or a cadaver). I would go see an American Board of Plastic Surgery certified surgeon with experience in rhinoplasty/revision rhinoplasty. You can look up if your surgeon is American Board of Plastic Surgery certified by Googling "is my plastic surgeon certified?".

Ali Sajjadian, MD, FACS · Answer

I understand your frustration with the asymmetry of your nostrils after two rhinoplasty procedures. It's common to seek further refinement, but understandably, you'd prefer to avoid another full surgery.
Here's what I can tell you about the situation:
Revision Rhinoplasty is Often Necessary: Revision operations are frequently sought by rhinoplasty patients to address problems that develop following the first procedure. This is due to the nose's intricate anatomy, which makes it impossible for even the most experienced surgeons tcan't always predict exactly how it will heal.
As you said, grafting is a popular procedure performed in revision rhinoplasty to give particular nose parts more volume or support.  This can be very useful for correcting asymmetry in the nose.    Non-Surgical Options Have Limitations.   Fillers are unlikely to significantly lower a nostril that is positioned excessively high, although they can be useful for certain minor nasal contouring difficulties. This is due to the fact that fillers increase volume without altering the nose's basic structure. As you've already experienced, fillers might not be the best option for you.
Redness May Be a Sign of Inflammation: There are a number of possible causes for the redness around your nostrils, such as underlying inflammation or discomfort from prior filler injections. To rule out any potential issues, it's crucial to have a doctor analyze this.
Speaking with a board-certified plastic surgeon with substantial expertise in revision rhinoplasty is the best method to find out if your nostril asymmetry can be fixed without a complete rhinoplasty. They may evaluate your unique anatomy and talk about the best course of action for you. While you may be hoping to avoid surgery, it's important to be open to the possibility that a limited surgical procedure may be the most effective way to achieve your desired outcome. . With minimally invasive methods, a skillful surgeon may frequently achieve notable changes.
As a triple Board-Certified Plastic Surgeon and experienced rhinoplasty surgeon, I specialize in revision rhinoplasty. This complex procedure requires meticulous attention to detail and a deep understanding of facial and nasal anatomy. I am committed to correcting imperfections and restoring both the form and function of the nose. My philospphy is to listen carefully to the goals and desirers of my patients with a focus on patient satisfaction, I utilize advanced techniques to achieve natural-looking and long-lasting results.
Hope this was helpful!
Best wishes,
Dr Ali Sajjadian

Richard G. Reish, MD, FACS · Answer

Hello and thank you for your question. Based on your photographs, you need a full revision rhinoplasty to correct your alar attraction with nostril asymmetry. Any less invasive procedures will simply not work. 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

William Portuese, MD · Answer

You have a combination of right sided alar retraction, and a hanging columella. A revision closed rhinoplasty can accomplish reduction of the hanging Colula, and placement of a composite graft from the ear to bring the right sided nostril downwards. This can be performed under either local or general anesthesia, depending upon patient's comfort and desires.

How to correct alar retraction without invasive procedure? (photo)

Answers (6)

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