Surgeon said he can’t fix my alar notching/retraction. Are all surgeons unable to fix this because of how severe it is? (photos)

Hello and thank you for your question. Based on your photographs, you alar retraction and columellar show can be improved with alar rim grafts and a cephalic rotation of your tip to turn up your tip slightly.  Make sure you specifically look at before and after pictures of real patients who have had this surgery performed by your surgeon and not just a computer animation system.  You should be able to view numerous pictures of actual patients with noses similar to yours performed by your surgeon.  If you cannot find enough real before and after pictures, then consider continuing your search for a surgeon.

Best wishes and good luck.


Richard G. Reish, M.D. FACS

Harvard-trained plastic surgeon
 

Rhinoplasty requires exceptional skill on behalf of the surgeon and great communication with the patient about realistic goals and expectations.
Common cosmetic concerns include a dorsal hump, wide nose, sunken nose, irregularities, and asymmetries. Functional concerns include difficulty breathing through the nose, which can and should be addressed at the same time as your rhinoplasty.
In your case, alar rim grafts from your septal cartilage (assuming you have an adequate supply) would address your stated concern. There is nothing severe about your condition. 
Make sure to seek out the care of a board certified surgeon with extensive experience in rhinoplasty. Find someone you connect with, who will listen to your concerns and provide you with a framework for what is possible.
Gary Linkov, MD
Rhinoplasty Specialist
Manhattan