Alar Batten grafts vs. LLC repositioning. What would be more beneficial to treating retracted nostrils and a pinched tip?

After multiple rhinoplasties some patients have anatomical elements inside their noses suffering a damage beyond repair, requiring not only suport, fixation or lengthening grafting but furthermore such anatomical elements have to be removed, discarded and be replaced by new ones, hand made and carefully and artistically handycrafted from donor cartilages taken from ear concha, septum, rib, etc.Second, it is absolutely impossible to predict or foresee what are the real internal damages, the final technical requirements and the definitive surgical plan in most revision rhinoplasties, especially in multioperated ones, until the surgeon opens, lifts the skinn hood and visualizes the anatomy once the fibrosis is carefully debrided.LLC repositioning sounds more for primary structure rhinoplasties rather than for revisions; in revisions the lateral cruras may need segmental grafting to repair damaged portions, struts, batten grafts, caudal extension grafts or, as mentioned, full replacement.Your case is likely for grafting or reconstructing the lateral cruras.

The question you are asking is a complicated one with likely more than one answer.  If you have had over resection of the lateral crura resulting in alar retraction and a pinched tip you are likely going to need to some form of cartilage grafting in order to strengthen the weakend structural supports of your nose.  LLC repositioning is not necessarily going to address this issue without large grafts are also placed along the lateral crura which will also act as batten grafts.  You may need alar rim grafts as well depending upon the appearance of your nostrils.  A thorough evaluation with a skilled revision rhinoplasty specialist would definitely be of benefit.  

If you are experiencing nasal congestion from nostril pinching, tip reconstruction may be necessary, and the type of reconstruction would require an examination. If your breathiung is fine, we have had great success with microdroplet Silikon1000 for adding volume to a pinched nasal tip, and lowering retracted nostrils. Hope this helps! Dr joseph

alar retraction secondary to overly aggressive cephalic trim of the lower lateral cartilages requires re-creating the defect by first releasing the scar that pulls the retracted alar rim up and repositioning the lateral crus inferiorly, then dealing with the lack of support at the core of the problem.... alar batton grafts are essential to this, but in my revision rhinoplasty practice, they are often insufficient.... most of the time, alar retraction also requires a ‘spacer’ in the form of a composite ear graft (skin and cartilage) placed on the inside of the nostril as well...Good luck...

Both nostril rim retraction and a pinched tip can both be caused by cartilage removal and corrected with small cartilage grafts. Pictures would be helpful and an examination by a revision specialist will be necessary to diagnose the cause of your problem.