Can a double alar rim graft that is too bulky be corrected? (photos)

Question

I have had 3 rhinoplasties. In the last surgery, my doctor placed a second piece of ear cartilage over an existing alar rim graft to help open my nostril which had collapsed on that side. Now, the nostril is wider, but the double rim grafts in the tip and along the rim are creating a very bulky appearance on the left profile. It has been one year since my last surgery; can the grafts possibly be reduced or smoothed to give a more natural, less prominent look? Thanks.

Robert Glasgold, MD, FACS · Answer

From the photos you have provided it is difficult to appreciate the bulky appearance you are referring to.  It is possible that a graft in the area could cause such a problem.  A first step would be an in person examination with an experienced revision rhinoplasty surgeon to both see and feel the area to try and determine the underlying cause.

Andrew Miller, MD · Answer

Evaluation of a nose can be difficult even when it has never been operated on. But when three procedures have been performed, simple pictures on a two dimensional computer screen are not sufficient to form a good opinion. From a simple viewpoint, your nose does not look overly bulky or unnatural, but a visit to a highly experienced rhinoplasty surgeon can result in a much better opinion. He or she can examine the nose inside and out, test its functionality, and look at it from all angles to determine what, if anything, can be done. Also, when additional grafts are put in a revision case, it can take even longer than a year for the skin to tighten down around them so it still may improve. Good luck.

Bahman Guyuron, MD · Answer

The best view to judge about the alar rim grafts are full profile and head tilted back (warms eye) views. It is hard to judge how thick these grafts are from the included photographs. In general, I prefer a septal or rib cartilage for the alar rim graft since a single layer ear cartilage is not firm enough to deliver the intended changes and a double layer graft is too bulky. One option is to replace the existing 2 grafts with a, preferably, septal cartilage graft (which I assume is not available otherwise the surgeon would have used that rather the ear cartilage) or a thin rib cartilage graft. However, a rib cartilage graft could be an overkill from the limited pictures that you have included. You may want these options with your surgeon.

Eric M. Joseph, MD · Answer

Based on your limited photos, you do not appear to have an unnatural-looking nasal appearance. The feasibility or advisability of performing a fourth rhinoplasty would need to be determined during a consultation with reputable and experienced rhinoplasty surgeons.Hope this helps you.Dr. Joseph

John Michael Thomassen, MD · Answer

Your photos show a very nice alar contour.  It is not that clear that the graft is too bulky but maybe this is an issue of photo quality.   Grafts can absorb a bit with time so one option is to wait and see how the graft behaves and it may not be an issue.  Discuss with you surgeon the option for thinning the graft but then it may not provide the support you need for the ala.  Best wishes!

Can a double alar rim graft that is too bulky be corrected? (photos)

Answers (5)

Answer: After three rhinoplasty surgeries, it may be best to reserve a fourth operation as a last resort.

Answer: After three rhinoplasty surgeries, it may be best to reserve a fourth operation as a last resort.

Answer: Alar rim graft

Answer: Alar rim graft

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.

Can a double alar rim graft that is too bulky be corrected? (photos)

Answers (5)

Answer: After three rhinoplasty surgeries, it may be best to reserve a fourth operation as a last resort.

Answer: After three rhinoplasty surgeries, it may be best to reserve a fourth operation as a last resort.

Answer: Alar rim graft

Answer: Alar rim graft

Browse related questions

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.