Rhinoplasty candidate for alar rim grafts
In our practice, alar rim grafts are used as a collar stay to prevent the alar rim from collapsing. Composite skin/cartilage grafts are used for alar retraction. A columella-plasty is performed to reduce the hanging columella. A thorough examination of the internal and external portion of the nose is required along with digital imaging to determine what may or may not be required. Rhinoplasty is a very difficult endeavor, so choose your surgeon very wisely based on extensive experience. A composite skin graft may increase the cost slightly, however alar rim grafts are part of the normal rhinoplasty when needed. For many examples, more information and our current price list, please see link and the video below
Excess columellar show treatment options
Yes, it would likely cost a bit more to bring the alar rims down in addition to tucking up the columella, but I would recommend going with the treatment plan that seems to work best for your nose. These results will be with you for a lifetime and it's a lot more straightforward to do it all at once rather than go back and try to do additional work later on.
I suspect that by doing in office digital simulations you and your surgeon would be able to get a better idea regarding how much columella tucking up and/or alar rim bringing down would be best in your situation.
You can read more about excess columellar show treatment at my web reference link below.
While cost is important to all of us, do not limit the procedure based on charges. Get the best possible result which will last a lifetime. If necessary save money a little longer before having surgery. The grafts will cost a little more than just lifting the columella; consul with a rhinoplasty surgeon for examination, recommendations, and costs.
Rhinoplasty costs vary based on surgeon, location, and sometimes if a portion of the procedure is being covered by insurance. Don't worry too much about the fee structure and whether extra steps increase your cost. If you want a certain result for your nose, this is not the time to look for the cheapest deal. Each surgeon knows what he or she needs to do surgically to get to the end goal. Speak to a few surgeons, find someone with whom you are comfortable from a doctor and cost perspective, and go for it!
Alar rim grafts can be used to help with alar rim retraction and help improve the aesthetics of the nostril show on a side view. If the columella is the problem, then sometimes a submucous resection of the caudal edge of the septum can help as well. It is hard to say from your photograph however, it is important to consult with a board certified plastic surgeon who understands your goals and has the ability to deliver results. Best of luck, MMT