Right nostril retracted. What can be done? (photo)

Question

I had a revision rhinoplasty last year and am happy with the results except that my right nostril is retracted. I mentioned this to my surgeon and was told that it would be too complicated to correct. Other doctors have said that I need a composite graft. Can this be done with local anesthesia or would I have to undergo a full revision surgery? Any recommendations of a surgeon in the bay area who can help? I'm okay with the left nostril. Thanks,

Thomas A. Lamperti, MD · Answer

There are a few ways of fixing a retracted ala. A rim graft can be very useful for repairing relatively mild cases of alar retraction. For more significant cases of alar retraction I often use lower lateral crural repostioning. This technique would need to be done in an operating room and involve mobilizing the tip cartilage on the side of the nasal tip that is retracted and then repositioning it lower down on the face. The end result is that the nostril margin is pushed down.You can read more about alar rim grafts at my web reference link below.

Umang Mehta, MD · Answer

Thanks for the question and photos. There are several ways to address retracted nostrils. The choice of which technique to use depends on the degree of retraction as well as whether there are any additional issues present in the tip. I frequently inject fillers in the nose but I do not inject fillers immediately along the nostril rims, due to the risk of compromising the nostril blood supply which can cause alar necrosis. For mild cases of retraction a rim graft can be placed. This is a thin sliver of cartilage which is taken from inside the nasal septum or from the ear. A small pocket is made along the inside of the nostril rim and the cartilage is slid into place. For moderate-severe cases of retraction, a composite graft can be used. This is a piece of cartilage with skin still attached that is taken from the portion of the ear called the concha cymba. This is the little "cave-like" portion of the external ear that sits about a centimeter above the opening to the ear canal. There is minimal to no change in the external appearance of the ear. Both of these above procedures can be done under local anesthesia or light IV sedation.Other options include the repositioning of the tip cartilages to push the nostril rims down. This maneuver is helpful if the tip cartilages are malpositioned, meaning that they are sitting up too high after a prior rhinoplasty surgery. Lastly, lateral crural strut grafts can be used. These are strong, straight pieces of cartilage taken from the septum, ear, or rib. These can help strengthen the lower lateral cartilages if they were overly thinned or weakened during a prior surgery. This can also help pinching or collapse of the sides of the tip and nostrils. I generally use an open approach for lateral crural strut grafts or repositioning, and in most cases, general anesthesia is preferable. One additional cause of extra nostril visibility is a hanging columella, the portion of the nose which sits between the nostrils. If the rims of the nostrils are normal in height but this columella is hanging, the nostrils will appear to be excessive in size. Correction of this issue may require shaving back of the septum or tucking the columella up to the septum with what we call a "tongue-in-groove" suture.  Looking at your photos, the degree of retraction of your right nostril appears to be moderate while the left is pretty mild. I would advise you to seek consultations with a few revision rhinoplasty specialists to make sure you've done your due diligence. The issue is relatively straightforward to correct in well-trained and experienced hands. Best regards,Dr. Mehta

Evan Ransom, MD, FACS · Answer

There are many surgical options for correction of alar retraction. In general, when this happens, it means that the tip cartilage on that side is pulled up too high.  This is often corrected with cartilage grafts. An examination in person would be needed to determine the best option; these include an alar rim graft and a composite graft.  Both of these grafts can be taken from the ear. In many cases, this can be performed in the office under local anesthesia. If you find yourself in the Bay Area, I would be happy to discuss more in person. Best of luck!#San Francisco Rhinoplasty

Michael A. Persky, MD · Answer

Hi CalmLotus,It appears that the degree of alar retraction can be corrected with an alar rim cartilage graft. Of course this would be determined best at your consultation.  Good luck and be well.Dr. P

Kenneth Hughes, MD · Answer

There are several surgical options that can be utilized.  Occasionally, filler may be a reasonable option as well.Kenneth Hughes, MDLos Angeles, CA

Right nostril retracted. What can be done? (photo)

Answers (9)

Answer: Correction of Slight Alar Retraction

Answer: Correction of Slight Alar Retraction

Answer: Right nostril retracted. What can be done?

Answer: Right nostril retracted. What can be done?

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Everything you need to know about Rhinoplasty

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Right nostril retracted. What can be done? (photo)

Answers (9)

Answer: Correction of Slight Alar Retraction

Answer: Correction of Slight Alar Retraction

Answer: Right nostril retracted. What can be done?

Answer: Right nostril retracted. What can be done?

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Recommended reading

Everything you need to know about Rhinoplasty

Our mission is to create a world where every investment in modern beauty is Worth It.