Alar Collapse Possible After Fourth Rhinoplasty?

This is my fourth Rhinoplasty. I had open rhinoplasty (two weeks post op). Everything seems okay except for nostrils. I'm noticing that one nostril is slanting in and other is straight up (it's not noticeable looking at my face, but when I lift my head up, I can tell).

My ENT said he will have to monitor my nose from collapsing because first plastic surgeon took all my cartilage to build up tip and dorsum. Will nose collapse within next couple of months or much later? I don't want another surgery!

What are the signs of alar collapse? Do I have the first sign of one nostril slightly slanting inwards? Will my breathing diminish over time? Is there anything I can do so I don't have to have another surgery?

Doctor Answers 3

Fourth revision rhinoplasty.

I hope you get an excellent result!

I'm glad your surgeon will monitor you closely. If you're breathing well through your nose, you won't need any further surgeries. In fact, a 5th surgery could lead to severe problems.

If there are any visible signs of collapse due to insufficient cartilage, you might benefit from injectable fillers, in the future, to restore symmetry. Now it's too soon to tell.

Good luck, and best regards.

West Orange Facial Plastic Surgeon
4.9 out of 5 stars 418 reviews

2 weeks after 4th Rhinoplasty


At only 2 weeks from your 4th revision rhinoplasty, I imagine you understand your healing process has only just begun. Much healing has yet to be occur! Because of your prior surgeries, we might only speculate on what may be causing the nostril asymmetry: It could be just swelling, or early asymmetry from cartilage grafts, tip sutures, or loss of support from weakened domes.

Asymmetric rim grafts can also make it appear that the nostrils are asymmetric. Only your surgeon knows your anatomy. If you can only detect the asymmetry from the nasal base view, it is minor and you shouldn't worry too much about it at this early stage. Alar collapse can occur when the lateral cartilages in the nose no longer support the overlying tip, or if there is weakness at any point along the tripod of the nasal tip. A weak interface at a critical point in the nose called the keystone can also contribute to alar collapse, and overlying heavy thick skin will aggravate things.

Alar collapse is typically associated with airway obstruction. My best advice is stay in close contact with your surgeon. He knows your anatomy, and what was done during the surgery, so only he can best guide you through your healing.

Randolph Capone, MD, FACS
Baltimore Facial Plastic Surgeon
4.7 out of 5 stars 51 reviews

Alar collapse is possible but there are ways to help prevent

Ask your surgeon about inserting a plastic stent-like device that would sit, hidden, inside the nostril and help prevent overtighting that might cause the collapse. It is important to do as much as possible to prevent that, particularly after several surgeries.

The doctor will be familiar with the types of stents, ring-like insertable and removable, devices that are available ro which can be custom made. To give you an idea as to the nature of these, check out: Max-Air Nose Cones. They are said to be "..suitable for post-operative stand and stabilize the nasal..cartilage of the valve."

Disclaimer: I have no business connection with this product, am merely aware of it by doing the research for you.

Robert Kotler, MD
Beverly Hills Facial Plastic Surgeon
4.8 out of 5 stars 86 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.