Is It Possible to Adjust Alar Rims that are a Lot Higher Than the Columella?

hi i wanted to ask about my nose. ive had a medpor implant and a columella strut placed in my nose. i also have had a alar base reduction procedure but ive noticed that evr since i had the latter that my alar rims are alot higher than tthe columella. and although my nasio labal angle is decent the nostril rim curves downward and to me it always makes me feel like i have a droopy nose. is there anyway to correct this. can the columella be taken further in so it cant be seen or can the alar be cut

Doctor Answers 6

Adjusting alar rims that are higher than columella

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Is it possible to adjust alar rims that area lot higher than the columella? 
The best way to reduce the alar columella disproportion is to perform a columelloplasty to trim any excess columella show, which will tuck the columella upward and inwards.  This is performed by trimming back both the membrane and cartilage of the columella.  In addition, if the arch of the alar rim needs to be brought downwards, composite skin grafts consisting of both skin and cartilage harvested from the ear can be placed inside of the internal portion of the nostril to expand and bring the nostril rim downward.  Both of these techniques are quite effective. 

Seattle Facial Plastic Surgeon
4.8 out of 5 stars 158 reviews

Elevated alar rims

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There are a few ways to lower alar margins that are retracted. The best method depends on how much movement is needed.

Alar rim grafts work well to correct more mild retraction. Lower lateral cartilage repositioning is a very powerful method to produce more significant improvement to the retraction.

An examination with a revision rhinoplasty specialist would allow for a better assessment of your options.

Thomas A. Lamperti, MD
Seattle Facial Plastic Surgeon
4.9 out of 5 stars 22 reviews

Is It Possible to Adjust Alar Rims that are a Lot Higher Than the Columella?

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I remember you case from a previous question regarding revision Rhinoplasty.  IMHO, you want to be very careful doing too much more to your nose after all the Rhinoplasty surgery.  It is possible to lower raised alae (alar notching) by using a composite ear graft.  I'd have to see front and side photos, of your nose, to make a further analysis.

Francis R. Palmer, III, MD
Beverly Hills Facial Plastic Surgeon
4.7 out of 5 stars 28 reviews

Alar rim

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How long ago was your surgery? I would like to see some photos as well as it is a difficult question to answer without seeing what your nose looks like.

Occasionally there may be some eary scar retraction that relaxes with time. If this is not the case then the nostril rim can be lowered but a graft may be needed.

It may be that the columella strut is too long. On the other hand it may not be wise to shorten the columella because it may distrupt the aesthetic nasal balance.

I would recommennd that you return to your surgeon and discuss your conscerns.

Isolde Hertess, MD
Gold Coast Plastic Surgeon

Alar Rim

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Yes, the alar rims can be lowered, however it would be best for you to have a personalized consultation with a board certified specialist who can better address your goals.

Kimberly Lee, MD
Beverly Hills Facial Plastic Surgeon
5.0 out of 5 stars 13 reviews

That's a complicated question!

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The short answer is yes, nostril rims can be lowered, but this is difficult! Often composite grafts from the ears are needed.  Balance between the nostril rims and the columella is critical in every rhinoplasty. Your photographs would help the doctors to provide a more specific answer. I am guessing you had a more "ethnic" nose? If so, final rhinoplasty results may take 1-2 years! Be patient, and take your concerns back to the original surgeon for a discussion of your options.

J. Charles Finn, MD
Raleigh-Durham Facial Plastic Surgeon
5.0 out of 5 stars 7 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.