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 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!

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.

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