Alar hooding reduction. Where is the incision made and can it be performed?

Question

Treatment of Alar hooding isn't commonly discussed in plastic surgery literature, but I was wondering if surgeons are familiar with any techniques to correct hanging/hooded alae (besides projecting the columella). I found only two journal articles describing excision of what seems like the alar rim but I wanted to confirm where this excision is made (inside/outside nostril)? I don't want weir excisions because I feel it will worsen the alar hooding; columellar grafts are already in my nose. Thank you!

Arian Mowlavi, MD, FACS (license on probation) · Answer

What you have to realize, is that during rhinoplasty, an area called the scroll is trimmed to improve supra-alar crease fullness and release the upper lateral cartilages from the lower lateral cartilages; This maneuver also allows for minimal trimming of the lower lateral cartilages to encourage them to flatten out when there is fullness in this region created by a convex cartilage. All of these maneuvers naturally cause the alar rims to retract up giving you the look you want without changing the columella. Please examples below and make a consultation to discuss details of what rhinoplasty could improve on your nose as well as to give you better alar rim to columellar proportions.

Frederic H. Corbin, MD (license restricted) · Answer

Thank you for the question and incisions are placed inside the nose and cartilage/ mucosa removed as neededDr. Corbin

Jon A. Perlman, MD (retired) · Answer

It sounds like you have already undergone rhinoplasty and probably have had resection of your cephalic lower lateral cartilages. In looking at your picture, I would have you discuss with your plastic surgeon the diagnosis of columella retraction and the option of placement of cartilage grafts along the anterior nasal spine and caudal septum.It is difficult to make such diagnoses based solely on a photograph and a face-to-face examination of course would be beneficial.Best wishesJon A Perlman MD FACSCertified, American Board of Plastic SurgeryAssoc. Clinical Prof. of Plastic SurgeryBeverly Hills, CA 90210

Alar hooding reduction. Where is the incision made and can it be performed?

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