What is the recovery time and complications for alar composite grafts?

Question

I'd like alar composite graft to reduce nostril view from the front, for both nostrils. I understand I need to talk to a doctor to determine if I am a good candidate. But I'd like to learn a few things first: -How long does it take for the ear and nose to mostly heal? (i.e. not noticeable that I had surgery, don't have to worry about the graft shifting). -Can it be done under local anaesthesia? -Are like retraction or scarring or necrosis particularly common with this procedure? Thanks much.

Ronald J. Edelson, MD · Answer

Composite nasal grafts are usually used for reconstruction either after an accident or skin cancer.  I don't think it is a good idea for the cosmetic purposes you are considering.

Myriam Loyo, MD · Answer

Hi there,You have a great question. Composite grafts are powerful technique to treat alar retraction.  Alar composite grafts are used to treat alar retraction in cases when the ala is missing cartilage support and inner lining. Here come some technical details. You can see if the ala is retracted on the profile view if you can see into the septum more than 2-3 mms or on the front view if you can see into the nostrils. The position of the columnella is also examined to make sure the columnella is not hanging low. If the columnella is hanging low, it can be repositioned superiorly. The ear heals very well and it is almost not noticeable. The grafts are secured well in place and shifting is not a problem. Unfortunately, placing composite grafts to treat alar retraction is not done under local. To treat alar retraction, a full rhinoplasty is still required to release the skin attachments and reposition cartilages to allow for the nostrils to rotate down. Not every retracted ala requires composite grafts, but it can be very effective in the right cases.Hope this helps!

William Portuese, MD · Answer

A full set of pictures are required before making any determination about specific techniques required. A composite skin graft is composed of both skin and cartilage, harvested from the ear and placed on the underneath side of the nostrils for alar retraction. When patients have a hanging columella, a columella plasty is performed. This is much more commonly done then composite skin graft. An alar rim graft is  used to when patient's have flail nostrils.

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

When it comes to alar positioning you have to take into consideration the position of the alar rim to the columella. The alar rim may be retracted but it might be that your columella is to protruded. Second, there are a variety of ways to correct alar retraction, including:1)a nasal mucosal V To Y advancement2)a alar rim contour graft3)a composite alar rim graft which is on the inside of your nose and not apparent.Please make a consultation to first diagnose your concern and to come up with a surgical plan.

Richard W. Fleming, MD (retired) · Answer

First you must determine if the problem is secondary to a hanging columella, alar rim retraction, or a combination of both. If there is alar retraction this can be treated with just a cartilage graft or a composite graft which is both skin and cartilage. There is little risk if any of these procedures are done by an experienced rhinoplasty specialist.

What is the recovery time and complications for alar composite grafts?

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