Is alar rim graft complex? What if it's the surgeon's first one? (Photo)

Question

How tricky is this for an experienced rhinoplasty surgeon if their first go at it? I have asked my surgeon and they were vague and have no before/after photos of rim grafts.

John Michael Thomassen, MD · Answer

This is a straightforward procedure, in which a strip of septal cartilage is placed along the rim.  In your case, I would also recommend a mucosal graft to ensure the retraction is fully corrected.

Eric M. Joseph, MD · Answer

Based on your singular photo, you appear to have had previous rhinoplasty surgery. I can see that you have nostril retraction and excessive nostril show. Sometimes this is due to an excessively long nasal septum, and sometimes this is due to excessive resection of nasal tip cartilage. Depending on your examination, microdroplet Silikon-1000 injections may be considered for lowering your retracted nostril and for smoothing your nasal bridge, without additional surgery. If the cause of your excessive nostril show is a long nasal septum, then revision surgery may indeed be necessary. Thank you for this question, and I hope it's helpful. Sincerely, Dr Joseph PS When it comes to rhinoplasty surgery (Especially revision surgery), it's never a good idea to be the first patient that a surgeon tries a new technique.

Richard G. Reish, MD, FACS · Answer

Hello and thank you for your question. Treatment of alar retraction is extremely complex.  You will likely require extended spreader grafts and appropriate tensioning of the tip.   You should only go to a surgeon with extensive experience in this area.

I highly recommend that my patients focus much more on real longterm before and after photographs rather than 3D imaging.   I encounter so many patients in my practice who see me for revision rhinoplasty who previously had surgery elsewhere who feel like they were mislead into surgery by surgeons who relied heavily on 3D imaging without adequate real before and after pictures to back it up.  Photoshop is easy but real surgery is very different.

I always recommend that you carefully evaluate your surgeon’s online before and after gallery on their website for both quality and quantity of results. Make sure that there are hundreds of real before and after pictures which demonstrate long-term follow up results. If your surgeon is posting mostly on table results without real long-term follow up results, that is usually a major red flag.  If a surgeon is posting mostly just splint removal day videos without longterm follow-up pictures, that can also be a red flag.   Long-term results are much more meaningful than on table results or 1 week post-op results.

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

Is alar rim graft complex? What if it's the surgeon's first one? (Photo)

Answers (3)

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