Alar rim graft for nostril retraction?
Your photo suggests to me that you will need more than a simple alar rim cartilage graft and instead a composite graft taken from the ear containing both cartilage and skin. This should be confirmed on a face-to-face physical examination.
Thank you for your question.
Jon A Perlman M.D., FACS
Diplomate, American Board of Plastic Surgery
Member, American Society for Aesthetic Plastic Surgery (ASAPS)
ABC-TV Extreme Makeover Surgeon
Beverly Hills, California
It is impossible to give recommendation on a very difficult surgical procedure without an in-person examination and a full set of facial and nasal photographs. Alar rim grafts help stabilize the alar rim from collapsing with inspiration. A composite skin graft( composed of skin and cartilage) is used to bring alar notching downward as in the photographs. Some patients need a reduction of the hanging columella, also shown in the photographs. For more information and many examples from our practice, please see the link and the video below
Alar rim grafts consisting or cartilage or cartilage and skin can be placed to lower your nostril rim. Nothing will be "in the way"; in fact the problem is cased by a retraction or lack of cartilage in this area.
Your nose needs more than the nostrils corrected. I prefer to use a composite(skin/cartilage) graft from the ear.It also appears that you need dorsal grafting and tip grafting. This can come from septal cartilage.A chin implant may also be in order.
How to fix alar retraction
Thanks for your question. There are a couple of ways to fix alar retraction. The choice of technique depends on the relation of other structures to the alar rim. Alar rim grafts are a classic way of fixing this. You create a pocket in the skin along the alar rim and slide a thin piece of cartilage into it. The pictures you attached seem like classic examples of this technique. Other techniques can be used but it all depends on what else is happening with your nose. Good luck!