Alar base reduction scarring. What can be done to revise scarring on nasal sill?

I had an alar base reduction that involved Weir excision, and also excision of alar hooding (which was not significant in my opinion) along the lower part of the alar rims. Unfortunately, the right nasal sill looks notched / distorted or "cut off". It looks as if the right nostril was cut and pasted on. It is creating asymmetry where the bottom of the right nostril looks shorter than the right nostril. What can be done to revise this? Can fillers or a graft be used to recreate the nasal sill border?

Doctor Answers 6

Alar base notching and scarring after Weir excisions

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Unfortunately, I do not see your attached photographs but alar base notching  where the base of the ala/nostril looks like it was just pasted on to the nasal sill can  result from the initial surgical planning and execution. It is rather difficult to fix but scarring can be significantly improved with just  old-fashioned mechanical dermabrasion. You can expect improvement  ranging from 50 to 75%. 
If one nostril is shorter than the other and somewhat straighter, it is difficult to re-create a curve and make a short nostril longer.  Generally, one can only shorten the longer nostril to achieve symmetry if the asymmetry was a result of a Weir excision/alar base reaction.   
Lowering a nasal rim can be achieved through a few methods. One can try filler and it can be quite successful at times, But you will only know for sure if you have had your doctor try it first. Another option would be a rim graft in mild cases or a composite auricular graft (skin and cartilage) in more severe cases. All are fairly successful.

Los Angeles Plastic Surgeon
4.6 out of 5 stars 56 reviews

Alar asymmetry and revision rhinoplasty

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The notch can be fixed with a re-excision and repair or grafting.  Because of scarring in the area, fillers don't work well.  Deciding between excision or grafting depends on the in-office exam.  The lateral area of the ala needs to come down to match the left.  If excision, the left will need to come in a bit more to match the right.  Best wishes.

David Alessi, MD
Beverly Hills Facial Plastic Surgeon
4.8 out of 5 stars 18 reviews

Revising alar base reduction scars

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Alar base reduction scars can be revised to improve the appearance of visible scars. 

Here are a few things your surgeon will consider when revising an alar base reduction.

1. A conservative re-excision. Too much will make the nostril too small and may affect function.
2. Symmetry. This is the best opportunity to make the nostrils match. 
3. Composite grafts. These are typically used for over-reduced nostrils.
4. Beveling. This is a technique to improve the scar visibility.

I recommend having a full consultation regarding this procedure, so you can understand the potential risks and the techniques appropriate for you. 

Victor Chung, MD
San Diego Facial Plastic Surgeon
5.0 out of 5 stars 10 reviews

Alar base reduction scarring. What can be done to revise scarring on nasal sill?

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Dear quidproquo

you can try simple re-excison and closure better known as scar revsion, however, the easy alternative is the raise deep part of scar with filler material ... with injections every 3 months. usually after 3-4 injections you can have an excellent resolution.

Afshin Parhiscar, MD
Bay Area Plastic Surgeon
4.8 out of 5 stars 58 reviews

Revision Alar Base Incision

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Dear quidproquo82, I would suggest that you seek consultation and after examination your best options can be discussed. You most likely need to have the incision revised. Best regards, Michael V. Elam, M.D.

Michael Elam, MD
Orange County Facial Plastic Surgeon
5.0 out of 5 stars 218 reviews

Alar base scarring

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I would recommend that you have your alar base reduction scar revised with a favorable bevel, so that you have eversion of your incision which will heal better.

Arian Mowlavi, MD, FACS
Orange County Plastic Surgeon
4.9 out of 5 stars 108 reviews

These answers are for educational purposes and should not be relied upon as a substitute for medical advice you may receive from your physician. If you have a medical emergency, please call 911. These answers do not constitute or initiate a patient/doctor relationship.