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

I wouldn't really call your situation alar notching. It's more of an exaggerated curve combined with droopiness of the tip. If the tip is lifted some and a cartilage graft is placed along the nostril rim to push it down a bit, an improvement should be attainable. Be sure to see more rhinoplasty experts for consultation.

I see and hear your concerns.  In experienced hands, I think your goal could be safely accomplished with either a rim graft or composite graft, along with a conservative rotation of the nasal tip.  As always, the best specific recommendations come from an in-person exam with a standardized set of photographs.  It may be in your interest to schedule some consults with Facial Plastic and Reconstructive Surgeons to get additional perspectives and discuss options in greater detail.  Best of luck!

Alar retraction is one of the reasons that people seek correction of the appearance of their nose.  There are various techniques for this and for your particular case, an alar rim graft placement, a relatively simple procedure, would likely make you happy.  More advanced alar contour issues require composite ear cartilage/skin grafting.  

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

Alar notching or alar retraction can be corrected through grafting techniques to the area.  The most frequent procedure is called an alar rim graft and can be quite helpful.  For more severe retraction, a composite graft of cartilage and skin is sometimes used and placed with in the nasal alar region to correct the problem.  Good luck to you as you explore your nasal correction.

Alar retraction/notching is treated by either alar rim cartilage grafts or chondrocutaneous ear grafts. While it can be difficult to consistently improve, this does not mean it is not possible.

I do not think you have  alar notching. It appears to be more like a flare.  Rim grafts can help with that, but be prepared  to have stiffer nostrils.

I would not characterize your alar notching as "severe" by any means.  In fact, I would not even describe it as notching.  You do have some excess curvature to the alar rims, but this is something that can definitely be improved by the use of alar contour grafts and other additional measures if necessary.  In addition, your columella and tip serve as the backdrop, or reference point for your alar rims.  Because your columella and tip are a little bit lower, it is contributing to the appearance of excess alar rim curvature.   The combination of slightly raising your tip and columella while also lowering your alar rims will bring the overall cosmetics of the nose into better balance.  The bottom line is that I believe your alar rims can definitely be improved as well as the overall cosmetic appearance of your nose.

I am very surprised that you were told the nostril rim retraction cannot be improved. Experienced rhinoplasty specialists see this problem during  consultations with patients who have inherited this nasal characteristic or  developed it after previous rhinoplasty surgery.